Systems and methods for drug dispensing

ABSTRACT

The present invention relates to systems and methods for the remote dispensing of packaged and non-packaged medical products using networked communications systems. A preferred embodiment of the invention utilizes a network to provide for the secure delivery of confidential patient information and the sending of dispense instructions to a remote dispensing station. A preferred embodiment of the present invention relates to systems and methods of dispensing samples of drugs or other medical products. Another preferred embodiment of the invention provides a system and method for dispensing non-prescription medications.

CROSS REFERENCES TO RELATED APPLICATIONS

[0001] This application is a divisional application of U.S. applicationSer. No. 09/454,359 filed on Dec. 3, 1999 which claims the benefit ofU.S. Provisional Application No. 60/155,446 filed Sep. 22, 1999, theentire teachings of the application being incorporated herein byreference.

BACKGROUND OF THE INVENTION

[0002] Automated pharmaceutical delivery systems have been in use forover thirty years. The initial purpose of such systems was to reduce thehigh rates of medication errors associated with manual distribution. Inmodem times, automated systems present more sophisticated advantages.These include further reduction of errors, lower costs associated withpharmaceutical distribution, reduction of personnel, inventory control,substance control, automated documentation, and relieving professionalpharmacists of many tasks.

[0003] The current state of the art of automated pharmaceutical deliverysystems, otherwise known as medication management devices generally fallunder three categories: automated devices in the central pharmacy area;automated devices in the patient care unit; and point-of-careinformation systems.

[0004] The primary goal of centrally-located devices is to replace orimprove the current manual process for filling unit dose carts. Thesedevices offer the advantage of a single, centralized inventory and alower overall inventory. Disadvantages of such devices include theirlarge size, high cost, and reliance on efficient delivery systems.

[0005] Patient care unit-based devices replace the traditional manualunit dose cart filling and delivery system and provide increased controlover floor stock. Advantages of such systems include their smaller sizeand lower cost relative to centrally-located devices, immediate accessto medications, and automated documentation of medicationadministration. Disadvantages include application to unit dose levelsonly, increased costs due to the maintenance of multiple inventories inmultiple units, additional time required to restock multiple devices,and larger inventory. Point-of-care systems are designed to enableimmediate exchange of patient data at the bedside. Such systems allowfor rapid access to patient information, fast documentation, integrationof hospital information systems, and immediate verification of drugadministration. Primary disadvantages of point-of-care systems includehigh cost associated with placing hardware in each room, networking thesystem, and security issues associated with personal data access.

[0006] The above-described systems offer solutions for medicationmanagement in large hospitals where the large expense associated withlarge centrally-located pharmacy systems, decentralized patient careunits, and point-of-care systems at the bedside are justifiable forunit-dose dispensing and verification. These systems fail to addressefficient and economical medication management at medium sizefacilities, for example health maintenance organizations which cannotjustify the expenses associated with the large and costly aforementionedsystems. Furthermore, while the above systems provide a solution forunit-dose dispensing for individual patients, they fail to address theissue of filling weekly or monthly prescriptions in a cost-effectivemanner.

SUMMARY OF THE INVENTION

[0007] The present invention relates to a method for remote dispensingof pharmaceuticals or other medical products using a distributed,interoperable, packet-switched network such as the Internet and to asystem that combines computer hardware and software, including acomputer network, a telecommunications capability, and a medicalproducts dispensing cabinet to form a complete drug dispensing system.The medical products may include, but are not limited to, packaged ornon-packaged pharmaceuticals or individual pills, caplets, tablets,liquids, or suspensions. This enables drug prescription dispensing involume by a physician, pharmacist, or other licensed practitionerdirectly to the patient at a clinic, group practice, or other locationoutside a pharmacy or a hospital. The system provides a convenient,safe, automated, and low cost drug delivery system for the patient.

[0008] A preferred embodiment of the present invention is directed to anapparatus and method for automated dispensing of packaged andnon-packaged pharmaceuticals. The remote control dispenser system of theinvention includes a centralized computer network in conjunction withproduct release at a remote location. The centralized networkcommunicates with the remote distribution point using standard InternetProtocols (IP) or higher level application protocols such as HypertextTransport Protocol (HTTP). In another preferred embodiment, a webbrowser can be employed as a tool to provide for the controlled remotedispensing of packaged and non-packaged pharmaceuticals. In anotherpreferred embodiment a customized web server can be employed as a toolto provide for the controlled remote dispensing of packaged andnon-packaged pharmaceuticals. The systems and methods of the presentinvention provide for the efficient remote dispensing of medicalproducts using widely available communications network technology whilepreserving the confidentiality of patient information and the safety ofusers based on restricted access to controlled substances.

[0009] A preferred system and method for remote dispensing of a medicalproduct, such as, for example, a prescription pharmaceutical includes anauthorization node, a dispensing node to distribute the authorizedmedical product, a controlling node that interfaces with theauthorization node and the dispensing node and a transmission mediumbetween the nodes. The authorization node can include a controller andappropriate software used by a pharmacist or a licensed physician. Thedispensing node can include a housing having a plurality of bins whichstore encoded packages of medical products and a dispenser controller.The controlling node, which may be collocated with the authorizationnode, includes a customized web server to control the flow ofinformation between the authorization and dispensing node.

[0010] A preferred embodiment of the present invention relates tosystems and methods of dispensing samples of drugs or other medicalproducts. Samples are often given to patients by physicians at clinics,offices, or hospitals. These samples are provided free of charge tophysicians or institutions for distribution to patients. At present,there are no systematic procedures for controlling the distribution ofsamples and there are increasing requirements by regulatory andaccrediting institutions to provide such controls.

[0011] Samples are usually packaged as unit doses in small foil and/orplastic containers with labels intended to identify a particular brandname or manufacturer so that the patient will then associate theparticular medication with a particular source. Thus, the packaging fordifferent samples from different sources tend to be varied in size andshape.

[0012] Thus, a system for containing and monitoring distribution inaccordance with the present invention includes a number of trays ordrawers in which the samples are stored, a control system that opens andcloses the system to provide access to the user and secures the systemto restrict unauthorized access.

[0013] A user identification system can be included that serves toidentify those gaining access to the dispensing system. This system caninclude a computer containing a catalog of medications dispensed usingthe system as well as patient data, or alternatively, accessing suchinformation using a communication network as described herein.

[0014] Another preferred embodiment of the present invention provides asystem for dispensing non-prescription medications or other medicalproducts that do not require a licensed physician or pharmacist to beinvolved in the transaction. Such a system can include a secure storagehousing that dispenses individual packages based on credit card, debitcard, cash, or other smart card transactions. The system can utilizefeatures of the communications network, code reader, and dispensingsystems described herein to provide for the distribution of “over thecounter” medical products.

[0015] The foregoing and other objects, features and advantages of theinvention will be apparent from the following more particulardescription of preferred embodiments of the invention, as illustrated inthe accompanying drawings in which like reference characters refer tothe same parts throughout the different views. The drawing are notnecessarily to scale, emphasis instead being placed upon illustratingthe principles of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

[0016]FIG. 1A is a diagram of a preferred embodiment of an automateddrug dispensing system in accordance with the present invention.

[0017]FIG. 1B is a perspective illustration of a rack of columns inaccordance with the present invention.

[0018]FIG. 1C is a perspective illustration of drawers of helixdispensers.

[0019]FIG. 1D is a perspective illustration of a system including helixand column dispensers in accordance with the present invention.

[0020]FIG. 2 is a flow diagram representing the processes performed bythe pharmacy technician at a Remote Control Dispenser (RCD) in aremote-dispense location and a registered pharmacist, R.Ph., at a remotecontrol location in accordance with the present invention.

[0021]FIG. 3 is a schematic block diagram illustrating the drugdispensing system in accordance with the present invention.

[0022]FIG. 4A is a schematic block diagram illustrating a drugdispensing system having a host system in one city and a remote drugdispensing system in different cities in accordance with the presentinvention.

[0023] FIGS. 4B-4C are schematic block diagrams illustrating thetransfer of information between the host system and the dispensingsystem in accordance with the present invention.

[0024] FIGS. 5A-5C are schematic block diagrams illustrating thesequence of the transfer of information between a host system and aremote drug dispensing system, using the Internet, in accordance withthe present invention.

[0025]FIGS. 6A and 6B are flowcharts illustrating the process todispense medications in accordance with the present invention.

[0026]FIG. 7 is a schematic block diagram illustrating a drug dispensingsystem having an integrated touchscreen computer and print module inaccordance with the present invention.

[0027]FIGS. 8A and 8B are schematic block diagrams illustrating a remotecontrol dispensing system which uses a server to control drug dispensingin accordance with the present invention.

[0028] FIGS. 9A(1) and 9A(2) are a schematic block diagram illustratinga preferred embodiment of the remote control dispensing system whichuses an internal data socket network configuration in accordance withthe present invention.

[0029]FIGS. 9B and 9C are flow charts illustrating the process todispense medications using the preferred embodiment of the presentinvention illustrated in FIGS. 9A(1) and 9A(2).

[0030] FIGS. 10A(1) and 10A(2) are a schematic block diagram of apreferred embodiment of the remote control dispensing system using theinternet and host pharmacy system network configuration.

[0031] FIGS. 10B-10D are flow charts illustrating the process todispense medications using the preferred embodiment of the presentinvention illustrated in FIGS. 10A(1) and 10A(2).

[0032]FIG. 11A is a schematic block diagram of a preferred embodiment ofthe remote control dispensing system using the internet networkconfiguration.

[0033] FIGS. 11B-11D are flowcharts illustrating the process to dispensemedications using the preferred embodiment of the present inventionillustrated in FIG. 11A.

[0034]FIGS. 12A and 12B are schematic block diagrams illustrating theuse of a telephone network in a drug dispensing system in accordancewith the present invention.

[0035]FIG. 13A is a schematic block diagram of a preferred embodiment ofthe remote control dispensing system using a telephone network directdial configuration.

[0036]FIGS. 13B and 13C are flow charts illustrating the process todispense medications using the preferred embodiments of the presentinvention illustrated in FIG. 13A.

[0037]FIGS. 14A and 14B are schematic block diagrams illustrating theuse of a pager service in a drug dispensing system in accordance withthe present invention.

[0038]FIGS. 15A and 15B are schematic block diagrams illustrating theuse of a satellite system to transfer information in a remote controldrug dispensing system in accordance with the present invention.

[0039] FIGS. 16A-16E illustrate views of the display screen that a userinterfaces with during a dispense process to dispense a drug sample inaccordance with a preferred embodiment of the present invention.

[0040] FIGS. 17A-17C illustrate views of the display screen that a userinterfaces with during a maintenance process including loadingmedications in accordance with a preferred embodiment of the presentinvention which includes dispensing of drug samples.

[0041] FIGS. 18A-18D illustrate views of the display screen that a userinterfaces with during a maintenance process including an inventoryprocess in accordance with a preferred embodiment of the presentinvention which includes dispensing of drug samples.

[0042] FIGS. 19A-19C illustrate views of the display screen that a userinterfaces with including a prescriber process in accordance with apreferred embodiment of the present invention which includes dispensingof drug samples.

[0043]FIGS. 20A and 20B illustrate views of the display screen that auser interfaces with during a transaction process in accordance with apreferred embodiment of the present invention which includes dispensingof drug samples.

[0044]FIG. 21 illustrates views of the display screen that a userinterfaces with during a history loading process in accordance with apreferred embodiment of the present invention which includes dispensingof drug samples.

[0045]FIG. 22 illustrates views of the display screen that a userinterfaces with during a report process in accordance with a preferredembodiment of the present invention which includes dispensing of drugsamples.

[0046]FIGS. 23A and 23B illustrate views of the drug sample dispenser inaccordance with the present invention.

[0047]FIGS. 24A and 24B illustrate views of a computer chassis locatedwithin the dispenser illustrated in FIGS. 23A and 23B.

[0048]FIG. 25 illustrates a view of a computer mounted on the chassislocated within the dispenser illustrated in FIGS. 23A and 23B.

[0049]FIGS. 26A and 26B illustrate views of a motion control systemlocated within the dispenser illustrated in FIGS. 23A and 23B.

[0050] FIGS. 27A-27D illustrate views of an embodiment of a bin locatedwithin the dispenser illustrated in FIGS. 23A and 23B.

[0051]FIG. 28 illustrates a view of an introductory display screen thata user interfaces with to dispense a non-prescription drug in accordancewith a preferred embodiment of the present invention.

[0052]FIG. 29 illustrates a view of a display screen showing inparticular a drug category selection screen that a user interfaces withto dispense a non-prescription drug in accordance with a preferredembodiment of the present invention.

[0053]FIG. 30 illustrates a view of a display screen showing inparticular a drug availability screen that a user interfaces with todispense a non-prescription drug in accordance with a preferredembodiment of the present invention.

[0054]FIG. 31 illustrates a view of a display screen showing inparticular a drug list screen that a user interfaces with to dispense anon-prescription drug in accordance with a preferred embodiment of thepresent invention.

[0055]FIG. 32 illustrates a view of a display screen showing inparticular a user identification screen that a user interfaces with todispense a non-prescription drug in accordance with a preferredembodiment of the present invention.

[0056]FIG. 33 illustrates a view of a display screen showing inparticular a ready-to-dispense screen that a user interfaces with todispense a non-prescription drug in accordance with a preferredembodiment of the present invention.

[0057]FIG. 34 illustrates a view of a display screen showing inparticular an ending screen that a user interfaces with to dispense anon-prescription drug in accordance with a preferred embodiment of thepresent invention.

[0058]FIG. 35 illustrates a detailed view of the preferred embodiment ofthe non-prescription drug dispenser in accordance with the presentinvention.

[0059]FIG. 36 illustrates a view of an embodiment of the helix trays ofthe non-prescription drug dispenser in accordance with the presentinvention.

[0060]FIG. 37 illustrates a view of the details of an embodiment of adoor installed in a preferred embodiment of the non-prescription drugdispenser in accordance with the present invention.

DETAILED DESCRIPTION OF THE INVENTION

[0061] The present invention relates to systems and methods for theremote dispensing of packaged and non-packaged medical productsincluding the methods for controlling a drug dispensing system describedin U.S. patent application Ser. No. 09/058,524 filed Apr. 10, 1998,which is a continuation of PCT/US96/16758, filed Oct. 18, 1996, which isa continuation-in-part of U.S. patent application Ser. No. 08/642,484filed on May 3, 1996, now U.S. Pat. No. 5,797,515 which issued Aug. 25,1998, which is a continuation-in-part of U.S. patent application Ser.No. 08/544,623 filed on Oct. 18, 1995, now U.S. Pat. No. 5,713,485 whichissued Feb. 3, 1998, the entire contents of the above patents andapplications being incorporated herein by reference.

[0062] The present invention provides safe pharmaceutical prescriptiondispensing directly by physicians, pharmacists, and other trained orlicensed practitioners operating in small to medium size locations in acost-effective manner. The dispensing locations can be remote from thelocation of a licensed practitioner such as, for example, a pharmacist.Prepackaged pharmaceuticals are stocked at nearby municipal servicecenters and distributed to the health care locations as needed. Theinventory is continually and automatically monitored by a host computerat the location, and/or off-site on a central server. Inventory isordered on a just-in-time basis by the computer. In this manner,prepackaged multiple-dose pharmaceuticals are available to practitionersat the health-care facility for immediate filling of patientprescriptions.

[0063] The present invention offers significant advantages to physiciangroup practices. The system improves customer service and enhances theimage of the group practice. Drug theft is prevented by securing thepharmaceuticals in a closed system on hand and inventory is kept low.The system meets state pharmacy, safety, and regulatory compliance laws,whereas many manual dispensing systems do not. A pharmaceuticaldistributor can handle all inventory planning, financing, maintenance,and ordering with minimal interaction with group practitioners.Disruptive telephone calls to the physician from pharmacists areminimized. Further, physicians can gain immediate access to a patient'spharmacy records currently unavailable to him.

[0064] Managed care providers, for example, Health MaintenanceOrganizations and Pharmacy Benefits Managers also realize significantadvantages from the present invention. The invention increases thelikelihood that a patient will receive the required treatment, becausethe pharmacy is available at the doctor's office. Labor costs forin-house pharmacies are reduced, allowing staff reductions orreassignments. In-house drug dispensing can be extended tophysician-staffed satellite clinics and other locations not suitableeconomically for conventional pharmacies. The system enables automatedpatient compliance enhancing programs, drug utilization analysis, andthe use of other emerging pharmacy management opportunities to reducecosts and improve patient compliance and wellness. Drug costs arereduced by formulary control, thereby encouraging generic substitutionof name brand drugs. Inventory is tracked automatically by the drugdistributor headquarters, thus preserving professional time for patientcare.

[0065] The present invention also offers significant advantages to thepatients. Drugs are provided immediately at the physician's office,avoiding an inconvenient trip to a pharmacy. This is particularlyimportant to mobility-impaired patients and eliminates a major source ofdrug non-compliance. Electronic third-party payor cards such as smartcards can be used for drug purchases at the doctor's office. The patientcan obtain prescription drugs at prices competitive with retaildiscounters. The physicians are able to track prescription compliancewhich can result in faster recovery.

[0066] The apparatus of a preferred embodiment of the invention will nowbe described. FIG. 1A is a diagram of an automated drug dispensingsystem in accordance with the present invention. The primary componentsof the system include a remote control dispenser (RCD) cabinet 20, ahost computer 46, a modem 52, a document printer 56, and a label printer54. The cabinet 20 includes a rack 24 comprising a plurality of bins,preferably in the shape of columns 34. Packages 32 such as drug bottles,containing pharmaceuticals of various types are distributed among thecolumns 34, each column 34 containing a separate type of pharmaceutical,or multiple columns 34 containing the same pharmaceutical to helpprevent stock outs on more frequently dispensed pharmaceuticals. Aplurality of racks, for example, four racks 24 are enclosed in thecabinet 20 chamber, two in the main cabinet 20 and two on the doors 22.The doors are secured by locks 28.

[0067] A licensed user, for example, a doctor, pharmacist, nurse, orother medical practitioner qualified to fill patient prescriptions,operates the system at the host computer 46, using a keyboard 50 andmouse 66 for input and receiving visual feedback at a monitor 48. In analternative preferred embodiment, a touch screen can be used for input.Using the keyboard 50, a user enters a command to request dispensing ofa particular packaged pharmaceutical variety 32 for a particularpatient. The computer 46 transmits the request via an interface 70 to acontroller 42 located on the RCD cabinet 20. The controller 42interprets the command sent from the computer 46 and enables adispensing actuator 68 in the appropriate column 34. The lowest package32 in the appropriate column 34 is released from the column 34 andejected onto a ramp 30. The released package 74 slides down the ramp 30into an opening 26, where the released package 74 is made available tothe dispensing party for transfer to the patient. A bar code reader 40,located near the dispensing opening 26, reads a code 98 on the dispensedpackage 74 and transmits the bar code information to the computer 46,which informs the user whether the code 98 on the dispensed package 74matches that which was requested by the user. The bar code 98 can bedisposed on the side, top, and/or bottom of the package 32. In analternative embodiment, a semiconductor chip can be embedded in thedispensed package which, when passed through an RF field, charges acapacitor. When the capacitor reaches an appropriate level, a weak RFsignal is emitted. The signal can include approximately a 12 digitnumber. The semiconductor chip can also be used to uniquely identify adispensed item.

[0068] In an automated embodiment of the system, sensors 36 located oneach column 34 monitor the dispensing process and notify the controller42 of any package jams. The sensors 36 also monitor inventory of thecolumns 34 and notify the computer 46 through controller 42 that aparticular column is empty or near empty.

[0069] Alternatively, the prescription can be dispensed directly to thepatient. A card reader 38, mounted directly on or near the cabinet, isadapted to receive a card 39 from a patient. The card is programmed withpatient information that is stored in an electronic memory on the cardby a licensed practitioner. The patient inserts the card 39 in the cardreader 38 and receives his medication automatically from the cabinet.The medication bottle 32 may be filled with a single dose of medicationfor a particular patient, or can include weekly or monthly doses. Thisembodiment is especially useful in large institutions, such as prisons,where many individuals require medication on a regular basis.

[0070] Upon validating the bar code 98 or the unique electronicsignature of the dispensed package 74, the computer generates a label 58containing prescription information at a label printer 54 to be placedon the package, and generates a document 60 at a document printer 56containing additional instructions for the patient or practitioner. Amodem 52 enables periodic or continuous communication between the hostcomputer 46 and other computers in the network so that a completeinventory and status of each remote control dispenser cabinet isavailable at all times. Several remote control dispenser cabinets 20 canbe integrated into a single installation operated by a single computer46. The cabinets 20 can each be individually connected to the hostcomputer 46, or may be daisy-chained, with only one cabinet 20 in thechain connected to the host 46.

[0071] The RCD controller 42 receives commands from and transmits statusinformation to the host computer 46 via the controller interface 70. Arequest command sent from the host computer 46 identifies thepharmaceutical package 32 to be dispensed. In response, the RCDcontroller 42 activates the appropriate dispenser 68, thereby releasinga single package of the variety requested. A parallel or serial I/Ointerface 62; at the host computer 46 provides a sufficientcommunication channel. The simplest interface is a unidirectionalchannel from the host computer 46 to the controller 42. A full dupleximplementation allows the controller 42 to transfer status informationback to the host 46. Status information may include errors such aspackage jams, empty columns, or other cabinet status. Availability ofsuch information prevents inconsistencies in the database and providesthe operator with recovery procedures. This would require adequatesensors 36 to be mounted in appropriate positions on the RCD cabinet 20.

[0072] The bar code reader 40 or an electronic digital signal reader canbe mounted directly on the unit or can comprise a hand-held unit 41. Itverifies proper loading of the RCD cabinet 20 and proper dispensing ofeach pharmaceutical package 32. Before a column 34 is loaded withpackages 32, the column bar code label 76 is compared with the bar codelabel 98 of each package 32 inserted into the column 34. Each time apackage 74 is dispensed from the cabinet 20, the package bar code label98 is scanned by the bar code reader 40 to verify that the correctpharmaceutical has been dispensed. The bar code reader 40 is interfacedto the host computer 46, through a standard keyboard wedge 64. The wedge64 makes the bar code reader 40 input via the bar code interface 72appears to be coming from the keyboard 50. Such an interface is a simpleand reliable interface to the pharmacy software operating on thecomputer 46. The bar code reader 40 must be highly reliable and providea high first read rate. Label printing on the pharmaceutical packages 32must be of high quality to accommodate this. The electronic digitalsignal reader interfaces with a communications port (comm port), anetwork interface card (NIC), or is in direct communication with thecomputer bus. During loading, the bottles are loaded into each column upto a certain height. The highest bottle in the column is positionedadjacent a bar coded column label 75 running along each column. Thus,the number of bottles in each column can be recorded at loading andtracked during use.

[0073] The host computer 46 runs the pharmacy software, provides a userinterface, and supports the RCD controller 42, bar code reader 40,printer, electronic digital signal reader, and modem 52. A standardoff-the-shelf personal computer and operating system are sufficient tomeet these requirements. As described above, the keyboard 50 and mouse66 receive input from the user and the monitor 48 provides visualfeedback. The document printer 56 prints documentation 60 such asdetailed instructions and a label printer 54 prints package labels 58,for example, prescription information 59 for adherence to the dispensedpackage 74. Using a combination label stock form, a single printer canbe used to provide both the patient label and patient educationmaterial. The prescription label 58 may also include a printed pictureof the pharmaceutical 57 contained on the bottle to provide additionalsafety.

[0074] The modem 52 provides a communication link between the municipalservice center (MSC) 106 and the remote control dispenser 108. Throughthis link, inventory of each RCD cabinet 20 is automatically monitoredand updated in the MSC 106 computer. The modem link also serves as amedium to issue restock orders, update pharmacy software running on thehost computer 46, and provide remote diagnostics. The modem can becompatible with standard telephone lines and can be capable oftransferring data at sufficient rates.

[0075] The pharmacy software operating on the host computer 46 is astandard commercial software package which provides standardadministrative and accounting capabilities. The pharmacy software alsosupports the unique features of the remote control dispenser system.These include: data communication with the RCD controller 42 viaparallel or serial I/O interface 62; network interface card (NIC); datacommunication with the bar code reader 40 via keyboard wedge 64; datacommunication with the municipal service center via modem 52; printingof labels 58 with the label printer 54 and printing of documentation 60with the document printer 56.

[0076] The cabinet 20 and rack 24 are preferably fabricated fromaluminum, stainless steel, or plastic to be fully compatible with aclinical setting. The rack 34 can be modified to provide for a diversityof packages including various box and bottle sizes, unit-of-usepackaging, liquids, syringes, and various non-prescription products, forexample, medical supplies.

[0077] The computer 46 can comprise a portable terminal, a notebookcomputer, or a hand-held personal digital assistant. Voice recognitionor voice prompted software can be employed using a telephone or wirelesslocal area network. Voice recognition systems can use a generic or auser-customized system and can include voice signatures. The objectiveis to maximize system flexibility and ease of use for the doctor andstaff without compromising safety. The remote control dispenser systemcan be utilized as a free-standing system, as a local network integratedwith physician office computers, or as a centralized network inconjunction with product release at a remote location.

[0078]FIG. 1B is a perspective illustration of a rack 110 of columns112. Each column 112 includes a corresponding roller assembly 114, whichis individually addressable by the controller to dispense a bottle 116as shown. After dispensing, a pusher 118 pushes the dispensed bottleforward into an off-center tilt tray 120 and returns to its originalposition. The tilt tray 120 rotates in the direction shown by arrow 123for removal of the dispensed bottle by the operator. Either a returnspring or gravity returns the tilt tray 120 to its closed position. Notethat the tilt tray 120 when opened by the operator prevents entry of theoperator's hand or other objects into the rack area 110 to avoidpilferage.

[0079] To load the columns 112, each rack 110 of columns slides out inthe direction shown by arrow 124. Each rack preferably includes a keylock at the top with a keying mechanism which retains the key until therack is returned to its position, preventing loss of the key. After thecolumns are filled, the rack is returned to its normal position and thekey is removed.

[0080]FIG. 1C is a perspective illustration of an alternative embodimentof the present invention. In this embodiment, drawers 120 of helixdispensers 122 are contained in a cabinet 124. The helix dispensers 122,when activated, rotate in a single direction. As the helix 122 rotates,any pharmaceutical packages disposed on the helix are pushed forwardtoward the front of the cabinet 124. One full rotation of the helix 122will cause the outermost package to be released, causing the package tofall into the bin 126. After the package drops into the bin 126, anoperator slides open the bin 126 and removes the package. While the binis open, a door blocks the opening between the bin 126 and thedispensing area to prevent pilferage. The helix-dispensing unitdescribed above is particularly suitable for packages of variousnon-standard sizes, for example boxes, bags, and kits. Larger-sizedhelixes 122 may be used for smaller packages. The helixes 122 are eachindividually driven by a stepper motor located in the rear of each tray.

[0081]FIG. 1D is a remote control dispenser embodiment well-suited foruse in a doctor's office or in a small clinic. The top unit 130 includesa column dispenser as shown in FIG. 1B. The bottom unit 132 includes ahelix dispenser as shown in FIG. 1C. This combination of dispenserscovers a range of package styles for controlled substances, tool kits,and bandages for a typical clinic.

[0082]FIG. 2 is a flow diagram representing the processes performed bythe pharmacy technician at an RCD and a registered pharmacist at the RPHworkstation in accordance with the present invention. Initially, apatient presents a prescription to a technician at an RCD unit 270. Thetechnician determines whether the drug is stocked in the RCD unit 271.If the pharmaceutical is not stocked, then the technician decideswhether to electronically transfer via facsimile, email, or otherwise,the prescription to an affiliate 272. If the prescription is transferredto the affiliated pharmacy, 273, the patient may travel to that pharmacyto receive the pharmaceutical. Otherwise, the prescription is returnedto the patient 274 to be filled at another RCD unit or by anotherpharmacist of the patient's choosing.

[0083] If the drug is stocked at the RCD unit, then patient data isretrieved 275, the drug is selected 276, the prescription signa isselected 277 and additional scripts may be entered 278. Following this,the identification number of the prescriber is entered 279 and all datais transmitted to the RPH workstation 280. At the RPH workstation, thepharmacist verifies the prescription 281 and performs a drug utilizationreview 282. If issues arise during the review, the pharmacist isimmediately made aware of the conflict and given an opportunity toreview and, if appropriate, override 283 the contra-indications 284. Ifthe pharmacist decides at this point to discontinue the dispensing 285,the process is aborted 294. If the pharmacist decides to continue thedispensing anyway 284 or there were no contra-indications 283 in thefirst place, then claim adjudication is performed 286. Duringadjudication 286, a patient's insurance information is automaticallyverified to determine whether the insurer will pay for the prescription,and if so, if any co-payment is required from the patient. If a negativeresponse is received 287, drug dispensing is aborted 291. Otherwise, thedrug is dispensed and verified with a bar code reader 288. If animproper drug was dispensed, the technician is notified to abort theprocess as a system failure has occurred 292. Upon system failureelectronic notification is performed. Distribution headquarters or aregional dispensing location or agent can be notified by the RCD systemif an incorrect dispense is shown. Electronic notification can take theform of a fax, email, file transfer, pager notification, or any otherelectronic transfer protocol. If verification is positive, a label isprinted and affixed to the bottle 290. The technician then must scan anadditional bar code that is created at the time of the printing. Thisbar code is located on the patient label now affixed to the dispenseditem. If verification of this last bar code is positive, theprescription is dispensed to the patient by the technician 293.

[0084] Referring to FIG. 3, the drug dispensing system 310 of thepresent invention includes computers attached to a computer networksystem, for example, the Internet 320. Three of the systems are RCDworkstations 322 which control the RCD hardware or dispensers 324. Acomputer system, represented by the laptop graphic, is the “ControllingPharmacist” computer 326. Another computer 328 is a server runningtypical website type software.

[0085] The operating system of the workstations 322 is preferably aWindows basedsystem, for example, Windows NT systems with access to theInternet via a modem or via a connection to a Local Area Network (LAN),which has access to the Internet. Each workstation 322 uses a browser(for example, Microsoft® Internet Explorer) to interact with the server328. The interaction entails getting patient information entered, druginformation, etc. Instead of a local executable, the Internet and abrowser are used. The server 328 sends permission to each workstation322 via the browser. The permission protocol is discussed in furtherdetail hereinafter.

[0086] In a particular embodiment, the server 328 runs Microsoft® NT,Microsoft® Internet Information Server (IIS) 4.0, ColdFusion™ and isconnected to the Internet 320 via a static Internet Protocol (IP)address. A static or dynamic IP or a unique domain name can be used.

[0087] The server 328 contains and maintains all the informationnecessary to dispense a drug. It effectively functions as a “mainframe.”

[0088] Once the dispense is appropriate that is there are no drugissues, and the patient can pay for the medication, the server 328passes to the client browser the necessary codes to cause the RCD 324 todispense the drug requested.

[0089] The pharmacy controller 326 is shown as a laptop to indicatepictorially that there is no attached hardware RCD's, etc. This systemalso requires access to the Internet 320 via a modem or LAN, and uses abrowser to interact with the server 328 and the workstations 322.

[0090] The drug dispensing method of the present invention is predicatedon the fact that most everybody has access to the Internet 320. When onelogs onto the Internet 320 one gets an IP address, which uniquelyidentifies a user. Access to the Internet can be through an existingconnection LAN, or using a Microsoft® utility for example, dial-upnetworking. The workstation 322 using a bookmark, or Internet ExplorerFavorites, or entering the domain name or IP address, connects to theserver 328. The server 328, for example, WebDirectRx.com has a passwordgate to control access and to establish which databases the workstation322 has access to. This reduces any confusion regarding the inventoryand dispense queues of networks, for example, in Utah, and Florida. Theworkstation 322 gets access from its user ID and password, plus a cookiethat uniquely identifies the installation, to the correct databases.Examples are the inventory database, patient database, transactiondatabase, and the dispense queue database.

[0091] The workstation 322 types into WebDirectRx.com the demographicsof a new patient, or selects an existing patient. Another preferredembodiment has a host pharmacy or hospital network share access topatient records within its own nodes, or dispense sites. The workstation322 selects and enters the Rx information. Rx Information is the dataneeded to process a drug Rx. It includes at least an account number,Rx#, Rx date, patient name, prescriber name, SIG, dosage, and insuranceinformation. This information is placed into a queue database that isaccessible for read only by the workstation 322. The Rx information isthen available to a pharmacy controller account, who has READ/WRITEaccess to the queue. The pharmacy controller 326 uses a browser, and hasgone through a password gate. The queue available to the pharmacycontroller 326 is based upon the user ID entered to keep the differentdispensing networks from sharing or intercepting data not pertinent untoitself.

[0092] The pharmacy controller 326 reviews the Rx information in thequeue, processes the information through a Drug Utilization Review (DUR)Process, and performs adjudication as needed. Once these services arecompleted the pharmacy controller 326 places into a dispense queue theRx information for the sending workstation 322. The sending workstation322 in turn, sees it has an item in its queue, and dispenses that itemusing one of the methods to dispense a drug from hardware using thenetwork as will be discussed later.

[0093] In a particular embodiment, the actual signal sent to the RCD 324is triggered by the pharmacy controller 326, assuming the RCD is in aready state to receive such a signal. Some states require the signal tobe controlled by the pharmacy controller 326, versus the caregiver infront of the dispenser. The pharmacy controller can control quite alarge network of workstations 322.

[0094] FIGS. 4A-4C schematically illustrate a host pharmacy system incity 1 connected to a remote dispensing system 340 in city 2 and city 3.The dispensing systems 340 are connected to a host interface controller342 which acts as a gateway and passes control to the host pharmacyworkstation 344. The information required to process a medicationprescription for example, patient information, patient allergies,disease, and medication profile, is sent by the dispense interfacecentral processing unit (CPU) 340 to the host interface CPU 342. Theinformation is processed by the host pharmacy server 346 then is sent toa pharmacy label printer 348 which in turn prints out a pharmacy labelfor the requested medication. The pharmacist at the host pharmacyworkstation 344 is sent the physician's prescription or a copy thereof.The physician's prescription can be in a variety of forms for example, aphysician's called in instructions, an electronic version, a scanned inversion from a scanner co-located with the remote dispensing RCD system324. The pharmacist interprets the physician's prescription instructionsagainst the label printed out by the printer 348. If acceptable, thepharmacist redirects the label to the host interface CPU 342 which noweffectively acts as a network printer. The host interface CPU 342 parsesthe output based on a set of instructions and extracts out theprescription information, for example, the patient's name, the name ofthe drug, SIGNA etc. The host interface CPU 342 then sends a signal, ordispense information, to the dispense interface CPU 340 in either city 2or city 3 via the Internet 320. Upon receiving the signal, the dispenseinterface CPU 340 dispenses the appropriate medication from the RCD 324.In the alternative, the dispense interface reconstructs the informationand presents it for dispensing from the RCD 324 by the co-locatedcaregiver. As described previously with the dispense interface CPU 340with respect to FIG. 2, the dispensed drug's bar code is scanned alongwith the printed label and provided to an end user.

[0095] FIGS. 5A-5C schematically illustrate the sequence followed totransfer information between a host pharmacy system in one city andremote dispensing systems in a different city. As illustrated in FIG.5A, a connection is first established between the host pharmacy systemand a remote dispensing system using a remote access engine 350. Eachlocation publishes the dynamically assigned IP address to an Internetwebsite 352.

[0096] As illustrated in FIG. 5B, the dispense system in city 3 queriesthe Internet website 352 for the dynamically assigned IP address of thehost pharmacy system. The dispense system then begins remote control 354of the host pharmacy system to create a medication prescription.

[0097] As illustrated in FIG. 5C, the host pharmacy system queries theInternet website 352 for the dynamically assigned IP address of thedispense system using a data socket 356. The host pharmacy system thensends the medication prescription release information to the dispensesystem using the IP address given by the Internet website 352.

[0098]FIGS. 6A and 6B are flow charts illustrating the process todispense medications using a remote controlled dispense system. Theprescriber, for example, a physician creates a prescription on paper orvia electronic means per step 360. The prescription is then given to thepatient or electronically delivered to a technician who is co-located ata dispense interface CPU 340 per step 362. If the prescription was givento a patient, the patient carries the Rx to a dispense interface CPU 340location per step 364. The prescription is presented to the technicianin step 366. The technician then faxes, or forwards the electronicallygenerated prescription to a host pharmacy location per step 368. Thetechnician uses the Internet 320 to connect to the host interface CPU342 per step 370.

[0099] The host interface CPU 342 also connects to the Internet 320 perstep 372. The technician enters patient demographics and prescriptioninformation in a host pharmacy software over a link per step 374. A drugutilization review (DUR) process is then conducted by the pharmacist perstep 376. This is followed by an adjudication process per step 378 ifrequired. A prescription (Rx) label is printed in the host pharmacysoftware on the pharmacy label printer 348 per step 380. The hostpharmacy then interprets the faxed or electronically generatedprescription with the output from the pharmacy label printer per step382. The host pharmacy then sends the prescription information to thehost interface CPU 342 per step 384. The host interface CPU 342 sendsthe prescription information to the dispense interface CPU 340 via theInternet 320 per step 386. The prescription is then placed into a queuefor the technician who is co-located with the dispense interface CPU 340per step 388. The technician then selects the prescription to bedispensed per step 390. The technician enters their unique user ID perstep 392. Upon being queried for a password, per step 394, thetechnician enters a valid password. If the password is accepted the itemis dispensed from the RCD 324 per step 396. The item's bar code is readto check if the correct item has been dispensed per step 398. If the barcode is accurate, as decided per step 400, a label containing themonograph and patient material is printed per step 402. The patientlabel bar code is then read for accuracy per step 404. A counsel requestis made to the patient per step 406. If a counsel is required per step408, then a telepharmacy connection is made between the dispenselocation 340 and the host pharmacy location per step 410. Once thepatient is counseled per step 412 the dispensing procedure is completed.If however, it is decided in step 408 that a counsel is not requiredthen the procedure for dispensing the medication is completed then.

[0100]FIG. 7 illustrates a particular embodiment of a remote controldispenser 324 having an integrated touch screen 420 and a print module422. This embodiment does away with the need for a workstationco-located with an RCD 324.

[0101]FIGS. 8A and 8B illustrate a particular embodiment of the remotecontrol dispense system which relies on a web server such as an Internetserver 430 as illustrated in FIG. 8A, or a customized web server 432 asillustrated in FIG. 8B. A browser 434 is used to control the dispensingof the medication or package from the RCD 324. The Internet server 430and the web server 432 effectively function as the host interface CPU342.

[0102] The drug dispensing method in accordance with the presentinvention includes at least one of the following different methods todispense a drug from hardware such as the RCD 324 using a computernetwork such as the Internet. A first method includes having the webbrowser which causes a local executable to launch which communicateswith the communications port (COMM PORT) of a workstation 340 andthereby the electronics in the RCD 324. This activates automatically inan unattended fashion, effectively like a batch file running.

[0103] A second method to dispense a drug from the RCD 324 using theInternet includes direct communications between the browser and the COMMPORT. An ADD-ON element is built for the browser that is downloaded eachtime a dispense signal is to occur, or only once (the first time) and itis called when needed.

[0104] A third method to dispense a drug from the RCD 324 hardware usingthe Internet is via a customized software application such as, forexample, a JAVA APPLET downloaded as part of the permission to dispense.The applet activates the COMM PORT and causes the dispense cycle.

[0105] Another method to dispense a drug is to have a local executablewhich is “WebEnabled” by having built into it a hypertext transferprotocol (http) or file transfer protocol (ftp) service which frequentlyscans a table on the server 328 for the needed codes to dispense anitem.

[0106] Another method to dispense a drug includes pcAnywhere. Bothsystems are connected to the Internet, one runs pcAnywhere HOST, theother pcAnywhere REMOTE. The remote, via the Internet 320, controls alocal executable—the dispense software—just by entering the host IPaddress, or searches a sub-net for any connected system running HOST.The dispense protocol remains the same as described herein before.

[0107] It should be noted that the software the technician interactswith can exist on an attached and co-located external computerconfiguration, or as an integrated computer using TouchScreen componentsbuilt directly into the RCD.

[0108] Referring to FIGS. 9A(1) and 9A(2), in this embodiment of thedispensing system an existing host pharmacy software system 470 with aco-located interface application server 476, and a remotely installeddispense location interact to provide pharmaceutical dispensing across awide geographic region. This preferred embodiment uses the Internet 482to communicate Rx dispense information. The host pharmacy softwaresystem 470, via the interface application server 476, sends Rx dispenseinformation onto the dispense location workstation 486. At the dispenselocation workstation 486 the local user, for example, a technician, ispresented with a queue of processed prescriptions received from the hostpharmacy software system 470.

[0109] The dispense location workstation 486 contains local executableprogram(s) that manage the connection to the internet 482, internet datasocket communications, data acceptance, inventory management, andvisually prepares the Rx information received from the interfaceapplication server 476 in an easy to read queue for the local caregiver,typically a technician. In addition the dispense location workstation486 communicates with the co-located Remote Control Dispenser (RCD) 490to dispense packaged pharmaceuticals, a printer 472, such as a laser jetor color jet printer to provide patient and record keeping materials, aswell as, a bar code scanner for doing quality checks during a dispense.The dispense location needs access to a telephone system to get a “dialtone”, or a LAN based Internet connection, in order to receive and sendcommunications.

[0110] The host pharmacy software 470 is maintained or run at thepharmacy control location. Typically these are small networks ofpharmacy workstations where a retail or hospital pharmacy team interactswith insurers computers to create the order that leads to the filling ofa drug to be handed to the patient.

[0111] The interface application server 476 is a computer that isco-located with the host pharmacy software system 470. It is used tocollect information (the Rx data) for a dispense from the host pharmacysystem and then forwards that information to the dispense locationworkstation 486 via the Internet 482.

[0112] Referring to FIGS. 9B and 9C, a typical workflow of theembodiment illustrated in FIGS. 9A(1) and 9A(2) include the followingsequence of steps. An Rx is generated by a Physician or caregiver usinga paperless method such as a PDA or TouchScreen or by usual methodsusing pen and paper, fax and scanners in step 504. The Rx informationtypically contains the patient name, prescriber name and DrugEnforcement Agency identifiers, instructions for the administration ofthe drug, drug name, and quantity to be given to the patient. The Rx istransmitted to different locations per step 506, for example, if the Rxis transmitted to a pharmacy control location via fax or an electronicmeans, the authorized dispenser, typically a pharmacist, interprets thetransmitted information. Alternatively, if the Rx is transmitted to adispense location electronically or physically delivered, a user,typically a technician can take authorized action.

[0113] Once entered into the host pharmacy system per step 516, the Rxis manipulated into the host pharmacy software system per step 518either by an authorized dispenser interpreting the Rx informationtransmitted directly to his/her location and then manually or through anelectronic interface transfers the Rx information into the host pharmacysoftware, or the technician has an option to transmit the information tothe authorized dispenser, pharmacist, for the pharmacist to manipulateas described hereinbefore or to remotely connect to the host pharmacysoftware via a variety of interfaces to transfer the Rx information intothe host pharmacy software system either manually or via an electronicinterface. The connection interfaces can be, but are not limited to,Symantec pcAnywhere directly, Symantec pcAnywhere via the Internet, orby a co-located WAN connection provided with the host pharmacy software.

[0114] Once the information is transcribed or transferred into the hostpharmacy software system a number of typical processes are applied tothe Rx information. The processes can be a Drug Utilization Review whichentails scanning the drug to be dispensed against the patient profilecontained within the host pharmacy software system to determine if anypharmaceutical contra-indications for dispensing exist. An example of aDUR can be a drug-to-drug interaction test, or a patient drug allergytest. A second typical process is an Adjudication process whereby thehost pharmacy Software system communicates with a pharmacy benefitmanagement computer to determine the patient's insurance coverage andpayment amounts, if any.

[0115] The Rx information, having been processed by the host pharmacysoftware system can generally then be determined to be a valid Rx whichcan be processed by the pharmacist. In a retail setting, the pharmacistthen triggers patient drug labeling to be produced by the host pharmacysoftware system and takes a large bottle of medications from the shelfand counts and places into a smaller bottle, typically called a vial,the number of tablets, caplets, or milliliter's called for by thephysician. The pharmacist then applies labeling and hands the drug tothe patient. When the dispense is processed in conjunction with theremote dispensing system, the pharmacist or authorized dispensertriggers a patient drug label to be produced by the host pharmacysoftware system, however, instead of the label being processed by aco-located printer (laser jet or dot matrix) the output is directed tothe interface application server. The interface application serveraccepts the Rx information as a printer stream per step 520, or througha direct electronic interface to the host pharmacy software systemnetwork constructs.

[0116] Per step 522, an application, such as, for example, Parse Engine,parses the output received by the host pharmacy software system intodiscreet data elements. Once the parsing is completed, the data is thenencrypted and is uniquely identified for transmission to the dispenselocation workstation via the Internet.

[0117] The information is received by the dispense location workstation,decrypted and is placed into a work in process queue that is accessed bylocal executable programs run by the technician per step 508.

[0118] The technician at the dispense location selects theRx-Drug-Patient to be dispensed from a list of one or more possible tobe displayed per step 510. The selections are shown as mouse selectablelines. Each line represents a different RX-Drug-Patient to be processedby the technician.

[0119] Upon selecting the Rx-Drug-Patient to dispense the technician atthe dispense location is queried if this is in fact the RX-Drug-Patientper step 524. If the answer to the query is no, the technician isreturned to the entire queue list as described above per step 512. Ifthe answer to the query is in the affirmative, the local executableprogram resident on the dispense location workstation examines a localinventory file that contains data specific to the drug requested to bedispensed per step 526. The drug contains a profile which includes butis not limited to current stock level, suggested restock levels, andcoordinate position within a single or plurality of RCD's.

[0120] The RCD receives a technician coordinate type communication fromthe locally resident executable. The X,Y coordinate represents alocation within a single or plurality of RCD's where the requestedpharmaceutical is stored for dispensing. The X,Y coordinate isdetermined by examining an inventory profile of the drug to bedispensed. Upon receiving the dispense signal from the dispense locationworkstation the RCD presents a drug to the technician per step 528.

[0121] As a result of the dispense occurring, the technician ispresented with an additional screen which requires the input of bar codedata embedded onto the label of the dispensed drug. A bar code readerco-located at the Dispense Location is used to read the bar code of theitem dispensed from the RCD per step 530. The technician reads the barcode into the screen to be examined by the resident dispensing software.

[0122] The bar code of the item dispensed is read into the residentdispensing software and is compared with the value of the bar codeexpected from the drug inventory profile. If the values match per step532 what the resident dispensing software is expecting, a patienteducation monograph, patient labeling, graphic representation of thedrug expected, and picture of drug expected are generated per step 536and delivered to the co-located printer. If the values do not match whatthe resident dispensing software is expecting, the user has threeattempts with which to scan or enter the expected values per step 534.If three failed attempts are made, the transaction is terminated withwarnings sent to appropriate parties like the authorized dispenser,technician, system operator, and pharmacy consultant via pager andemail. Appropriate drug disposal and storage is maintained via trainingof the technician and an additional lock storage box within the RCD.

[0123] The technician at the dispense location is presented with oneadditional bar code on the patient label that is to be affixed to theitem dispensed. The technician is required to perform one more bar coderead by scanning the patient label after it is affixed to the itemdispensed per step 538. The bar code of the item dispensed is read intothe resident dispensing software and is compared with the a value of thebar code expected, the Rx number. If the values do not match what isexpected, then the user has three attempts to scan the correct labelbefore an error condition is reported per step 542. If the values domatch per step 540, then the dispense is complete and the localtechnician is returned to the view of the queue show work in process, ifany.

[0124] If the patient, who has been remotely administered medicationshas any questions an authorized pharmacist is available for consultationusing a variety of telepharmacy systems, including, but not limited to,a telephone system audio visual connection 488, a networked audio visualconnection, and an internet connected audio visual connection.

[0125] Referring to FIGS. 10A(1) and 10A(2), in another preferredembodiment of the present invention an existing host pharmacy softwaresystem 560 with a co-located interface application server 566, and adesigned web server 574 work in conjunction to provide a third location,the dispense location, with prescription information enough to identifyand then dispense a pharmaceutical.

[0126] The dispense location uses a web browser, such as, for example,Microsoft® Internet Explorer 5.0, instead of a locally installedexecutable. The web browser then interacts with data on a Web Server574. The web server 574 gets its data from the interface applicationserver 566 which is co-located with a customers Pharmacy software system560.

[0127] The dispense location is where the RCD cabinet 582 is located,along with a personal computer 580, a printer 562 such as a laser jetprinter, and a bar code scanner. This site has connectivity through anetwork or telephone system to the internet 576.

[0128] The pharmacy control location is where the host pharmacy softwareis maintained or run. Typically these are small networks of pharmacyworkstations where a retail or hospital pharmacy team interacts withinsurers computers to create the order that leads to the filling of adrug to be handed to the patient. The wholesalers have discovered amethod to keep distribution by supplying retail outlets with pharmacysoftware that automatically places reorders with the wholesalerscomputers based upon use and an inventory threshold stockout level. Anexample of pharmacy software that can be used, but is not limited to,with the present invention is McKesson HBOC Pharmaserve software.

[0129] The interface application server 566 is a computer that isco-located with the pharmacy software system 560. It is used to collectinformation such as, for example, the Rx data for a dispense from thehost pharmacy system and then forwards that information to the webserver 574 in accordance with the present invention. The web server 574,runs ColdFusion™ with a Structured Query Language (SQL) 6.5+database.The web server stores data sent to it, and displays that data in an easyto understand point and click format. The web server 574 is connected tothe Internet 576 at a static IP address using a Universal ResourceLocator (URL) such as, for example, StarNetLite.COM. The web server 574handles secure transmission of the data as well as the segmentation ofdata based upon a user login id/profile.

[0130] Referring to FIGS. 10B-10D, a typical workflow, illustrated as aflow chart, includes the following sequence of steps. Per step 604, anRx is generated by a physician or caregiver using a paperless methodsuch as a personal data assistant (PDA), such as, for example, a palmpilot, or TouchScreen or by usual methods using pen and paper, fax andscanners. The Rx information typically contains the patient name,prescriber name and Drug Enforcement Agency identifiers, instructionsfor the administration of the drug, drug name, and quantity to be givento the patient. Per step 606, the Rx can be transmitted to differentlocations. For example, if the Rx is transmitted to the web server 574directly, then the image or Rx data is stored to an appropriate table onthe web server for retrieval by a user authorized to dispensemedications, typically a pharmacist. In the alternative, if the Rx istransmitted to a pharmacy control location via fax or other electronicmeans, the authorized dispenser, typically a pharmacist, interprets thetransmitted information. If the Rx is transmitted to a dispense locationelectronically or is physically delivered, a user, typically atechnician can take the authorized action upon the Rx.

[0131] Once the Rx is entered into the host pharmacy system per step610, the Rx is manipulated into the host pharmacy software per step 612using different methods. For example, an authorized dispenser reviewsthe web server 574 captured Rx information in a 10 browser, and then,transfers that Rx information manually or through an electronicinterface into the host pharmacy software. Alternatively, an authorizeddispenser interprets the Rx information transmitted directly to his/herlocation and then manually or through an electronic interface transfersthe Rx information into the host pharmacy software. The technician hasan option, to either transmit the information to the authorizeddispenser, pharmacist, for the pharmacist to manipulate as describedhereinbefore, or to remotely connect to the host pharmacy software via avariety of interfaces to transfer the Rx information into the hostpharmacy software system either manually or via an electronic interface.The connection interfaces can be, but are not limited to, SymantecpcAnwhere directly, Symantec pcAnywhere via the Internet, and by aco-located wide area network (WAN) connection provided with the hostpharmacy software.

[0132] Once the information is transcribed or transferred into the hostpharmacy software system, a number of typical processes are applied tothe Rx information. The processes can be, for example, a DrugUtilization Review (DUR) which entails scanning the drug to be dispensedagainst the patient profile contained within the host pharmacy softwaresystem to determine if any pharmaceutical contra-indications fordispensing exist. An example of a DUR can be a drug-to-drug Interactiontest, or a patient drug allergy test. A second typical process is anAdjudication process whereby the host pharmacy Software systemcommunicates with a pharmacy benefit management computer to determinethe patients insurance coverage and payment amounts, if any.

[0133] The Rx information, having been processed by the host pharmacysoftware system can generally then be determined to be a valid Rx; whichcan be processed by the pharmacist. In a retail setting, the pharmacistthen triggers patient drug labeling to be produced by the host pharmacysoftware system and takes a large bottle of medications from the shelfand counts and places into a smaller bottle, typically called a vial,the number of tablets, caplets, or milliliter's called for by thephysician. The pharmacist then applies labeling and hands the drug tothe patient. When the dispense is processed in conjunction with the webserver, the pharmacist or authorized dispenser triggers a patient druglabel to be produced by the host pharmacy software system, however,instead of the label being processed by a co-located printer (forexample, a laser jet or dot matrix printer) the output is directed tothe interface application server.

[0134] The interface application server accepts the Rx information as aprinter stream per step 614, or through a direct electronic interface tothe host pharmacy software system network constructs. An application,such as, for example, Parse Engine, parses the output received by thehost pharmacy software system into discreet data elements per step 616.The parse engine, having completed parsing the data, then encrypts thedata and uniquely identifies the data for transmission to the web server574 via a network or dial-up Internet connection per step 616.

[0135] The information is received by the web server and placed into awork in process dispense queue/SQL database with flags identifying thedispense information as “belonging” to a particular dispense locationper step 624. This is a method designed to permit many simultaneousdispense locations to use the same SQL database.

[0136] The dispense locations then have access to the data in the workin process table presented as an HTML document (web page). Only datadesignated as belonging to a dispense location is available to adispense location.

[0137] The technician at the dispense location selects theRx-Drug-Patient to be dispensed from a list of one or more possibilitiesto be displayed per steps 640, 642. The selections are shown as HTTP“hyperlinks”.

[0138] Upon selecting the Rx-Drug-Patient to dispense, the technician atthe dispense location is shown a dispense detail Page. The dispensedetail page presents to the technician additional information about theRx, not practically visible above. The technician has a choice ofdeleting the Rx-Drug-Patient selection, or the “GO BACK” to earlier stepand select another, or to dispense the drug from the co-located RemoteControl Dispenser (RCD) 582. The Rx-Drug-Patient selection delete causesan early termination event which is communicated to the pharmacist viaan email as an option, and is captured to the correct early terminationdatabase for review later or in real-time by the pharmacist orauthorized dispenser. The “GO BACK” step prompts the technician toreturn to the previous list of available dispenses in the work inprocess table represented by displaying them as a queue on a web page.The selection to dispense the drug from the co-located RCD continues theprocess by requesting final dispense authority from the web server.

[0139] Final dispense authority is received from the web server in theform of a single web page, HTML document, that expires quickly so thatrepeat requests for the same drug cannot be made by reversing thebrowser using its imbedded back button. The web server 574 completes onemore check to determine if the drug requested is still in the local RCDinventory and the location of the drug within the RCD per step 632. EachRCD contains an Identifier, for example, from 0 to 9 (10 total) and from00-27, or 00-59 columns, depending upon the configuration. As part ofthe final dispense authorization the web server returns the exactposition of the drug desired within a single or plurality of RCD's. Theuser clicks a button or link and a series of different options canoccur. For example, a JAVA APPLET communicates with the RCD passing theRCD the data culled from the web server. In the alternative, a browserADD-IN communicates with the RCD passing the RCD the data culled fromthe web server. In another embodiment, a local one-time use executableis downloaded that communicates with the RCD passing the RCD data culledfrom the web server. Alternatively, a local executable is launched whichpasses the needed variables and communicates with the RCD 582 passingthe RCD data culled from the web server 574. In yet another embodiment,an alpha numeric page is sent to an integrated pager reception unitplaced within the RCD, which passes the needed variables andcommunicates with the RCD passing the RCD data culled from the webserver.

[0140] As a result of the dispense occurring, the technician ispresented with an additional web page which requires the input of barcode data embedded onto the label of the dispensed drug. A bar codereader co-located at the dispense location is used to read the bar codeof the item dispensed from the RCD per step 652. The technician readsthe bar code into the browser and clicks a test hyperlink, or in someinstances the bar code reader can interact with the browser directly andselect the test hyperlink directly.

[0141] The bar code of the item dispensed is read into the browser andis compared with the value of the bar code expected. If the values matchwhat the web server 574 is expecting, a patient education monograph,patient labeling, graphic representation of the drug expected, andpicture of drug expected are generated and delivered to the technician'sbrowser for subsequent printing to a co-located printer per step 658.However, if the values do not match what the web server is expecting,the user has three attempts with which to scan or enter the expectedvalues per step 674. If three failed attempts are made, the transactionis terminated with warnings sent to appropriate parties like theauthorized dispenser, technician, system operator, and pharmacyconsultant via pager and email. Appropriate drug disposal and storage ismaintained via training of the technician and an additional lock storagebox within the RCD.

[0142] The technician at the dispense location is presented with oneadditional bar code on the patient label that is to be affixed to theitem dispenses. The technician is required to perform one more bar coderead by scanning the patient label after it is affixed to the itemdispensed per step 664. The bar code of the item dispensed is read intothe browser and is compared with the a value of the bar code expected,the Rx number. If the values do not match what is expected, then theuser has three attempts to scan the correct label before an errorcondition is reported per step 672. If the values do match per step 668,then the dispense is complete and the local technician is returned tothe view of the queue show work in process, if any.

[0143] Referring to FIG. 11A, in this embodiment of a dispense systemthe majority of the features and functions use a web server 706 on theInternet 708. Thus, no longer does a local EXE (executable program)reside on the computer at the dispense location (where the RCD 714 isco-located to dispense drugs). Instead the dispense location CPU 710uses an Internet browser 712 to interact with the web server 706 toaccess patient information, drug selection, inventory control, anddispense permission.

[0144] Referring to FIGS. 11B-11D, a flow chart of a typical workflow ofthe referred embodiment shown in FIG. 11A includes the followingsequence of steps. An Rx is generated by a physician using a paperlessmethod such as a personal data assistant (PDA), or by usual methodsusing pen and paper per step 724.

[0145] The Rx is transmitted to a pharmacy control location per step 726whether by an electronic means for a PDA device, or fax for pen andpaper method.

[0146] The pharmacy control location's pharmacists (Rph) or designatedpharmacy technician, is logged onto the Internet, or logs onto theInternet using a local Internet Service Provider (ISP) per step 728.This device can be a PDA, a laptop, a cell phone with browser ability,or even a typical personal computer. Any device that is compatible with,but not limited to, HTML or XHTML or similar emerging protocol, can beused.

[0147] Using a device, for example, a laptop computer, the RPh ortechnician enters a URL (web address) such as, for example,WebDirectRx.com or gets this URL from her favorites List on the browserper step 730.

[0148] The RPh then enters her user id and password per step 732. Thisuser name and password carries with it a profile. This profile thenpermits different functionality on the web server 706 available to theperson logging in. A RPh gets a functionality not available to otherslike Rx generation, and the ability to see multiple dispensing queuesacross the network of dispensers.

[0149] If the patient is new, the RPh needs to enter patientdemographics, insurance information, allergies, disease states, drugprofile, et al., before beginning to generate an Rx per step 734.

[0150] The RPh then generates the Rx per step 736 by selecting thepatient, drug, prescriber, SIG, tity, refills, ICD-9 (a disease code ifknown), etc.

[0151] The generated Rx is then run through a process called DUR (DrugUtilization Review) per step 746 to examine the drug forcontra-indications against the patient profile. For example, allergies,and drug to drug interactions are examined here. In this embodiment, theprocess is executed on the server 706. The RPH or technician thenapproves the results of the DUR per step 748 or cancels the Rx or picksa more appropriate therapy.

[0152] The RPH or technician then runs an Adjudication on the patient todetermine if the patient is insured through a pharmacy benefitmanagement company per step 752. This process returns a status of, forexample, PAID per step 754, REJECTED, etc. A copay amount, among otheritems, is returned with a PAID claim.

[0153] The Rx is then placed into a queue per step 758 which thedispense location can see using its own browser. The dispense locationcaregiver, for example, a nurse, doctor, technician, also needs to belogged onto the Internet. This user/caregiver logs onto the web serverat, for example, WebDirectRx.com with a user id and password per step760. This user id and password carries with it a user profile per step764. The user profile indicates that this person is a dispenser, and canonly view the queue for his/her location per step 766. Theuser/caregiver sees his/her Rx—the one communicated to the RPh earlierand can now act upon that Rx as it has been approved per step 768.

[0154] The user/caregiver then clicks on the item to be dispensed. Thistriggers the web server to double check inventory per step 770 andacquire the location of the drug in the co-located RCD. When completed,the web server returns a page that the user can click on again to causethe computer to send a dispense signal to an RCD per step 776. Thesignals, as described hereinbefore, can be sent using different options,such as, but not limited to, JAVA APPLET, browser add-ins, and launchinglocal executables.

[0155] The RCD then dispenses the item. Whilst doing that, the webserver 706 presents to the user a screen whereby the user can bar codescan the dispensed item's bar code per step 780. Upon entry of the barcode a test per step 790 is made to see if the item is a repackaged itemor a manufacturer's packaged item per step 786. If it is amanufacturer's packaged item, then the web browser presents the userwith places to enter a lot number and expiration date per step 794. Therepackaged item has built into the bar code a lot number and expirydate.

[0156] If the bar code of the item entered is what the web server, forexample, WebDirectRx.com is expecting, then the web server presents theuser/caregiver with a completed patient label, patient educationmonograph, receipts, and image of pill, tablet, capsule etc., that isthen to be directed to a co-located laser jet printer per step 796. Onceprinted per step 798, the patient label, which contains a second barcode, is also scanned into a page presented to the user per step 800.The transaction details are written to a database on the web server, andthe user/caregiver is returned to the queue view from where this processstarted initially.

[0157] If the patient, who has been remotely administered medicationshas any questions, an authorized pharmacist is available forconsultation using a variety of telepharmacy systems including, but notlimited to, a telephone service audio visual connection, a networkedaudio visual connection, and an Internet connected audio visualconnection.

[0158]FIGS. 12A and 12B illustrate the use of a telephone network 440 inthe drug dispensing system in accordance with the present invention. Thetelephone network 440 transfers information between the host interfaceCPU 342 and the RCD 324. A wireless phone 442 can be integrated with theRCD. The telephone network 440 takes the place of or is used inconjunction with the Internet as a mechanism to transfer informationbetween the host pharmacy system represented by the host interface CPU342 and the host pharmacy workstation 344 and the remote dispensingsystem represented by the RCD. The wireless phone device acts as thetrigger mechanism to dispense pharmaceuticals or medical products out ofthe RCD. The wireless phone device can communicate with an integratedcircuit within the RCD transferring the RCD information obtained duringa wireless connection.

[0159] It should be noted that previous preferred embodiments aredisclosed with respect to using a communications cable or link between acontrolling CPU and the RCD to transfer a dispense message. Thecommunications cable can be replaced with a wireless phone device thus,facilitating dispensing via a wireless connection.

[0160]FIG. 12B illustrates a dispense interface CPU 340 and a laserprinter 444 co-located with the RCD 324. The remotely controlleddispense session can be managed entirely without land lines. Thewireless phone connection can be integrated into the RCD or in thealternative, as an attachment to, the dispense CPU. The wireless phoneconnection serves as the connectivity media instead of the internetconnection.

[0161] Further, as described hereinbefore, the software the technicianinteracts with can exist on an attached and co-located external computerconfiguration, or as an integrated computer using TouchScreen componentsbuilt directly into the RCD.

[0162] Referring to FIG. 13A, in this embodiment of a dispensing systeman existing host pharmacy software system 850 with a co-locatedinterface application server 856, and a remotely installed dispenselocation interact to provide pharmaceutical dispensing across a widegeographic region. This preferred embodiment uses the existing localtelephone service available. The interface application server 856 andthe dispense location workstation 868 connect and exchange Rxinformation directly with one another.

[0163] The dispense location workstation 868 contains local executableprogram(s) that manage the call pickup, data acceptance, inventorymanagement, and visually prepares the Rx information received from theinterface application server in an easy to read queue for the localcaregiver, typically a technician. In addition, the dispense locationworkstation 868 communicates with the co-located Remote ControlDispenser (RCD) 872 to dispense pharmaceuticals, a printer 870, forexample, a laser jet or color jet printer to provide patient and recordkeeping materials, as well as, a bar code scanner for doing qualitychecks during a dispense. The dispense location needs access to thetelephone service 864 to get a “dial tone” in order to receive and sendcommunications.

[0164] The pharmacy control location is where the host pharmacy softwareis maintained or run. Typically these are small networks of pharmacyworkstations where a retail or hospital pharmacy team interacts withinsurer's computers to create the order that leads to the filling of adrug to be handed to the patient.

[0165] The interface application server 856 is a computer that isco-located with the host pharmacy software system. It is used to collectinformation (the Rx data) for a dispense from the host pharmacy systemand then forwards that information to the dispense location workstation868 via the telephone service, or the telephone network 864.

[0166] Referring to FIGS. 13B and 13C, a typical workflow includes thesequence of steps illustrated. An Rx is generated by a physician orcaregiver using a paperless method such as a PDA or TouchScreen or byusual methods using pen and paper, fax and scanners per step 902. The Rxinformation typically contains the patient name, prescriber name andDrug Enforcement Agency identifiers, instructions for the administrationof the drug, drug name, and quantity to be given to the patient.

[0167] The Rx is transmitted to different locations per step 904. If theRx is transmitted to a pharmacy control location via fax or anelectronic means, the authorized dispenser, typically a pharmacist,interprets the transmitted information. If the Rx is transmitted to adispense location electronically or physically delivered, a user,typically a technician can take authorized action.

[0168] The Rx is manipulated into the host pharmacy software system perstep 914 either by an authorized dispenser who interprets the Rxinformation transmitted directly to his/her location and then manuallyor through am electronic interface transfers the Rx information into thehost pharmacy software or by the technician who has an option totransmit the information to the authorized dispenser, pharmacist, forthe pharmacist to manipulate or to remotely connect to the host pharmacysoftware via a variety of interfaces to transfer the Rx information intothe host pharmacy software system either manually or via an electronicinterface. The connection interfaces can be, but are not limited to,Symantec pcAnywhere directly, Symantec pcAnywhere via the Internet, by aco-located WAN connection provided with the host pharmacy software.

[0169] Once the information is transcribed or transferred into the hostpharmacy software system a number of typical processes are applied tothe Rx information. The processes can be a Drug Utilization Review or anAdjudication process as described hereinbefore.

[0170] The Rx information, having been processed by the host pharmacysoftware system can generally then be determined to be a valid Rx whichcan be processed by the pharmacist. In a retail setting the pharmacistthen triggers patient drug labeling to be produced by the host pharmacysoftware system and takes a large bottle of medications from the shelfand counts and places into a smaller bottle, typically called a vial,the number of tablets, caplets, or milliliter's called for by thephysician. The pharmacist then applies labeling and hands the drug tothe patient.

[0171] When the dispense is processed in conjunction with telepharmacysystems, the pharmacist or authorized dispenser triggers a patient druglabel to be produced by the host pharmacy software system 850, however,instead of the label being processed by a co-located printer 852 (laserjet or dot matrix) the output is directed to the interface applicationServer 856.

[0172] The interface application server accepts the Rx information as aprinter stream per step 916, or through a direct electronic interface tothe host pharmacy software system network constructs. An application,Parse Engine (PE), parses the output received by the host pharmacysoftware system into discreet data elements. Once the parsing iscompleted, the data is encrypted and is uniquely identified fortransmission to the dispense location workstation via telephone serviceper step 918.

[0173] The information is received by the dispense location workstationdecrypted and placed into a work in process queue that is accessed bylocal executable programs run by the technician per step 906.

[0174] The technician at the dispense location selects theRx-Drug-Patient to be dispensed from a list of one or more possible tobe displayed per step 908. The selections are shown as mouse selectablelines. Each line represents a different RX-Drug-Patient to be processedby the technician. Upon selecting the Rx-Drug-Patient to dispense thetechnician at the dispense location is queried if this is in fact theRX-Drug-Patient per step 920.

[0175] If the answer to the query is no, the technician is returned tothe entire queue list as described above per step 922. If the answer tothe query is in the affirmative, the local executable program residenton the dispense location workstation examines a local inventory filethat contains data specific to the drug requested to be dispensed perstep 924. The drug contains a profile which includes, but is not limitedto, current stock level, suggested restock levels, and coordinateposition within a single or plurality of RCD's.

[0176] The Remote Controlled Dispenser (RCD) receives a X,Y coordinatetype communication from the locally resident executable. The X,Ycoordinate represents a location within a single or plurality of RCD'swhere the requested pharmaceutical is stored for dispensing. The X,Ycoordinate is determined by examining an inventory profile of the drugto be dispensed. Upon receiving the dispense signal from the dispenselocation workstation the RCD presents a drug to the technician per step926.

[0177] As a result of the dispense occurring, the technician ispresented with an additional screen which requires the input of bar codedata embedded onto the label of the dispensed drug. A bar code readerco-located at the dispense Location is used to read the bar code of theitem dispensed from the RCD per step 928. The technician reads the barcode into the screen to be examined by the resident dispensing software.

[0178] The bar code of the item dispensed is read into the residentdispensing software and is compared with the value of the bar codeexpected from the drug inventory profile. If the values match whatresident dispensing software is expecting per step 930, a patienteducation monograph, patient labeling, graphic representation of thedrug expected, and picture of drug expected are generated and deliveredto the co-located printer per step 934. If the values do not match whatthe resident dispensing software is expecting, the user hasthreeattempts with which to scan or enter the expected values per step 932.If three failed attempts are made, the transaction is terminated withwarnings sent to appropriate parties like the authorized dispenser,technician, system operator, and pharmacy consultant via pager andemail. Appropriate drug disposal and storage is maintained via trainingof the technician and an additional lock storage box within the RCD.

[0179] The technician at the dispense location is presented with oneadditional bar code on the patient label that is to be affixed to theitem dispensed. The technician is required to perform one more bar coderead by scanning the patient label after it is affixed to the itemdispensed per step 936. The bar code of the item dispensed is read intothe resident dispensing software and is compared with the a value of thebar code expected, the Rx number. If the values do not match what isexpected, then the user has three attempts to scan the correct labelbefore an error condition is reported per step 940. If the values domatch then the dispense is complete per step 942 and the localtechnician is returned to the view of the queue showing work in process,if any.

[0180] If the patient, who has been remotely administered medicationshas any questions an authorized Pharmacist is available for consultationusing a variety of telepharmacy systems, including, but not limited, toa telephone service audio visual connection, a networked audio visualconnection, and an internet connected audio visual connection.

[0181]FIGS. 14A and 14B illustrate the use of a pager service 450 incombination with the Internet 320 to dispense medication from a remotelocation. The pager service 450 interacts with the Internet 320 totransfer information between the host pharmacy system represented by thehost interface CPU 342 and the host pharmacy workstation 344 and theremote dispensing system 324. A receive/send pager 452 interfaces withthe RCD 324 and transfers information regarding the dispensing ofmedication. A print module 454 can be integrated with the RCD. FIG. 14Billustrates an embodiment having a dispense interface CPU 340 and alaser printer 444 co-located with the RCD 324.

[0182] In a preferred embodiment, a pager service can forward dispenseinformation via an alpha/numeric page. A computer, such as, for example,but not limited to, an Aqcess Technologies Qbe Personal ComputingTablet, can be integrated with the RCD. In another preferred embodiment,the computing function can be accomplished using a combination of anexternal and integrated computer.

[0183]FIGS. 15A and 15B illustrate a preferred embodiment which uses asatellite system 460 to transfer information between a host pharmacyinterface CPU 342 and a remote dispensing system or RCD 324. TheInternet 320 transfers information from host interface CPU 342 to asatellite 460 via a satellite dish 462. The satellite in turn using asatellite send or receive module 464 transfers information to thedispense interface CPU 340 at a remote location from the host pharmacysystem. The dispense interface CPU then directs the dispensing ofmedication from the RCD 324. As illustrated in FIG. 15B a touch screencomputer 466 and a print module 468 can be integrated with the RCD whicheliminates the need for a dispense interface CPU 340.

[0184] In a preferred embodiment, the remote dispensing location is sentRx dispense information via a satellite network, such as, for example,the Iridium paging or telephone network. The dispensing workflow remainsthe same, only the connectivity to the RCD 324 changes.

[0185] According to another embodiment, a method of managing samples isa necessity in the highly regulated and cost control environment thatexists in healthcare today. The current haphazard approach to samplingis both costly and inefficient for all parties concerned and provideslittle useful information to any party.

[0186] The Joint Commission on Accreditation of Healthcare Organizations(JCAHO) is citing healthcare institutions for failure to document andmanage pharmaceutical samples. Drug cost control is a critical factorand formulary management, via the sampling process, is an importantcomponent in that overall process, especially in outpatient andindependent practitioner settings.

[0187] The Joint Commission is citing hospitals and integrated deliverynetworks (IDNs) for failure to properly manage physician samples. Theimpact of a negative Joint Commission finding can be severe.Nonadherence with state and federal laws puts prescriber's licenses atrisk, and violation of JCAHO-specified criteria in the drug samplingarea can lead to a Type 1 citation and endanger the healthcareorganization's accreditation status. Many insurance companies andgovernment programs, such as Medicare/Medicaid require JCAHOaccreditation before they will reimburse that institution for medicalcare of its patients.

[0188] JCAHO requires the institutions to have a policy on drug samplesand requires a control system that tracks the receipt and distributionof each drug sample. Further, the samples have to be properly labeledfor patient use (including any auxiliary cautionary statements andexpiration dates). The pharmacy department has to include drug samplesin its process for responding to drug recalls and in its monthlyinspection routine. This is the reason for tracking lot numbers andexpiration dates. Drugs need to be stored so that unauthorizedindividuals do not have access to them, such as, for example, by using alocked cabinetry or room. JCAHO also requires the institution to keep adrug sample receiving log that tracks date, drug name, strength, form,lot number, manufacturer, received amount, expiration date of drug, andlocation of storage. In addition, JCAHO also requires either a drugdispensing log or a drug sample dispensing database that includes thefollowing information date dispensed, patient name, drugname/strength/form, lot number, manufacturer, amount dispensed,directions for use, and physician name. The physician/pharmacist has toprovide medication counseling per certain congressional regulations.This could be in the form of a drug monograph with the followinginformation: name of medication, length of therapy, possible sideeffects of the medication, and expiration date and proper storage of themedication.

[0189] Uncontrolled sampling is driving up costs for physicians,patients and payers of all kinds. Drug companies need alternatives whichgive them information, reduce costs and retain access to prescribingphysicians.

[0190] There are differing regulatory schemes in different jurisdictionsthat exist for drug samples and the dispensing thereof. The regulatoryschemes address issues such as, for example, drug control license;patient's chart or clinical record to include record of drugs dispenseddelegating authority to dispense drugs; storage of drugs; containers;labels; complimentary starter dose drug; information; inspection oflocations; limitation on delegation; and receipt of complimentarystarter dose drug's pharmacist. Further, the regulatory boardsperiodically inspect locations from which prescription drugs aredispensed.

[0191] Under some regulatory schemes, a prescriber who wishes todispense prescription drugs obtains from a board a drug control licensefor each location in which the storage and dispensing of prescriptiondrugs occur. A drug control license is not necessary if the dispensingoccurs in the emergency department, emergency room, or trauma center ofa hospital or if the dispensing involves only the issuance ofcomplimentary starter dose drugs.

[0192] Per regulations, a dispensing prescriber can dispenseprescription drugs only to his or her own patients. A dispensingprescriber has to include in a patient's chart or clinical record acomplete record, including prescription drug names, dosages, andquantities, of all prescription drugs dispensed directly by thedispensing prescriber or indirectly under his or her delegatoryauthority. If prescription drugs are dispensed under the prescriber'sdelegatory authority, the delegatee who dispenses the prescription drugshas to initial the patient's chart, clinical record, or log ofprescription drugs dispensed. In a patient's chart or clinical record, adispensing prescriber has to distinguish between prescription drugsdispensed to the patient and prescription drugs prescribed for thepatient. A dispensing prescriber has to retain information required fornot less than, for example, five years after the information is enteredin the patient's chart or clinical record.

[0193] Regulations further include that a dispensing prescriber has tostore prescription drugs under conditions that maintain their stability,integrity, and effectiveness and assure that the prescription drugs arefree of contamination, deterioration, and adulteration. A dispensingprescriber has to store prescription drugs in a substantiallyconstructed, securely lockable cabinet. Access to the cabinet has to belimited to individuals authorized to dispense prescription drugs incompliance with the regulatory schemes.

[0194] Unless otherwise requested by a patient, a dispensing prescriberdispenses a prescription drug in a safety closure container thatcomplies with the poison prevention packaging act, for example, of 1970,Public Law 91-601, 84 Stat. 1670.

[0195] Further, a dispensing prescriber has to dispense a drug in acontainer that bears a label containing all of the followinginformation: the name and address of the location from which theprescription drug is dispensed, the patient's name and record number,the date the prescription drug was dispensed, the prescriber's name, thedirections for use, the name and strength of the prescription drug, thequantity dispensed, the expiration date of the prescription drug, or thestatement required per regulations.

[0196] Additionally, per the regulations, a dispensing prescriber whodispenses a complimentary starter dose drug to a patient has to give thepatient at least all of the following information, either by dispensingthe complimentary starter dose drug to the patient in a container thatbears a label containing the information or by giving the patient awritten document which may include, but is not limited to, a preprintedinsert that comes with the complimentary starter dose drug, thatcontains the information: the name and strength of the complimentarystarter dose drug, directions for the patient's use of the complimentarystarter dose drug, and the expiration date of the complimentary starterdose drug.

[0197] Per some regulations, a supervising physician may delegate inwriting to a pharmacist practicing in a hospital pharmacy with ahospital licensed the receipt of complimentary starter dose drugs otherthan controlled substances. When the delegated receipt of complimentarystarter dose drugs occurs, both the pharmacist's name and thesupervising physician's name has to be used, recorded, or other wiseindicated in connection with each receipt. A pharmacist may dispense aprescription for complimentary starter dose drugs written or transmittedby other means of communication by a prescriber.

[0198] Per the regulations, “complimentary starter dose” means aprescription drug packaged, dispensed, and distributed in accordancewith state and federal law that is provided to a dispensing prescriberfree of charge by a manufacturer or distributor and dispensed free ofcharge by the dispensing prescriber to his or her patients.

[0199] Referring to FIGS. 16A-27D, a preferred embodiment of the presentinvention includes a way to manage the sampling process and providesolutions to the persistent regulatory compliance issues and escalatingpharmaceutical costs. The embodiment fully documents the sample processand addresses all the JCAHO standards. The preferred embodiment alsoplays a significant role in better formulary management via informationcaptured through the sampling process. The cost savings realized throughthis process benefit all constituents of the healthcareindustry—patients, providers, and payers. Following are two examples ofthe preferred embodiment's contribution to controlling drug costs.

[0200] Firstly, generic drug sampling can greatly reduce an overallpharmacy drug budget. A recent study, conducted by Scott & WhitePrescription Services, evaluated the cost savings achieved afterimplementation of a generic drug sampling program. Results showedsavings per antibiotic prescription of over 10% of total prescriptiondrug cost for antibiotics. Greater savings were shown for nonsteroidalanti-inflammatory medications. Drug sampling of nonsteroidalanti-inflammatories (NSAIDS) resulted in over 30% savings perprescription cost in this therapeutic category. Among the generalconclusions of the study, generic drug sampling helped increase usage ofgeneric medications and decrease average health plan cost perprescription, while allowing for opportunities to influence prescriptionhabits.

[0201] Secondly, drug sampling can selectively reduce medication costsfor economically disadvantaged. In a study conducted al the Universityof Arizona Department of Pharmacy Practice and Science, it wasdetermined that Medicare managed care beneficiaries adopted predictablebehaviors to cope with capped prescription drug benefits. The findingssuggest that a considerable proportion of Medicare managed careenrollees take steps (i.e. obtain a medication sample, take less thanthe prescribed amount of medication, and using an over-the-counterproduct to replace the prescribed medication) to avoid facing the fullfinancial impact of their prescription drug costs.

[0202] There are several benefits of the preferred embodiment inaccordance with the present invention. The benefits are gained byphysicians and pharmaceutical companies. For example, the pharmaceuticalcompanies can get specific information about the prescriber,demographics on the patient without identification, competitive usagefactors and site specific information using the preferred embodiment.

[0203] Further, the distribution costs are lowered using the preferredembodiment of the present invention, enabling better use of themarketing representatives of the pharmaceutical companies. Lower wastageof samples due to strict controls over access and usage are realizedwith the preferred embodiment. Additionally, continued access tophysicians is gained because the institution is able to meetaccreditation standards. The preferred embodiment also provides theability to get national rollout virtually overnight through informationdissemination directly to users of sites employing the preferredembodiment. The preferred sample dispensing, is embodied by twocomponents. A hardware component comprising uniquely designed cabinetry,and a touch screen software component.

[0204] In the preferred embodiment, the software, for example, iswritten for Microsoft® Windows 98 and Microsoft® Windows NT, usingVisual Basic 6.0 and Visual C++, and runs on a typical Intel/Pentiumbased personal computer. Although disclosed with respect to beingwritten for Microsoft® Windows, the software may be written for anycomputer operating systems, for example, JAVA platforms, UNIX system,Windows CE, and IBM OS operating systems. The operating requirements,imposed upon the personal computer are minimal, permitting the purchaseof less expensive, though proven, computer components. Printers such as,for example, a Laser Jet or Color Ink Jet printer which provides apatient specific education monograph and labels with each dispense areused with the computer. The laserjet printer can also be used to printreports locally. Typical components include, for example, but are notlimited to, ASUS motherboards, Intel Pentium II CPU's, 3COM 3C90Xnetwork interface cards, digital hard drives of between four and sixgigabytes capacity, internal or external 3COM US Robotics modems, andMicroTouch touch screens.

[0205] The software is used by a nurse, physician, or medical officestaff, depending upon state laws and regulations. The functionality ofthe software breaks down into five main categories, namely, dispensingfunction, loading function, maintenance, reports, and communications.

[0206] All information transmitted, whether through the internet or adirect connection, is encrypted. An encryption program that is used, butnot limited to, is for example, “Blowfish.” In addition, the key bitexceeds 128-bits for sites located within the United States. Any siteslocated outside of the borders of the United States will use key bitencryption strength approved by the US government, such as for example,56-bit key lengths. According to some public safety regulations a key of128-bit meets or exceeds the level deemed necessary to transmitinformation over the Internet or other electronic means.

[0207] All information generated by the users input is captured in atransaction database for transmittal via the internet, or direct modemdial out, to a server. Inventory is maintained perpetually withincreases to the stocking level managed via the load process, anddecreases in inventory managed by the dispense process. Inventory stocklevels are also communicated to a server, with special attention tostockout threshold levels to trigger additional communications withclinic managers, chiefs of pharmacy, manufacturers, and any othersinvolved in the sample dispensing value chain.

[0208] All information captured is aggregated in the server. Thecommunications function of the samples dispensing software manages theaggregation process. At present time, throughout a 24 hour period, thecommunication module can deliver the days activity of an individualsample dispensing location to the server. This information isaccumulated and is available for redistribution using a variety of waysand methods.

[0209] Distribution of each sample dispensing location's informationoccurs in at least one of two ways, depending upon the availableinformation infrastructure. Where telephone access is available thesample dispensing locations can call, using an 800 number, a server,setup for receipt of up to 24 simultaneous connections. This type ofserver is commonly referred to as a Remote Access Server (RAS). The RAScan be set up with 24 ports or more capable of 56K connections using aT-1 data line. Additional simultaneous connections are available ingroups of 24, 36, 128, or higher. If toll free access is not acceptable,the sample dispensing location can call a local Internet ServiceProvider access number, and then negotiate a session with the serveralso connected to the Internet.

[0210] If modem access is not possible, then an existing hospitalnetwork running a protocol such as, for example, TCP/IP is used if thathospital can access the Internet. The sample dispensing location isconnected to the hospital network to transmit daily activity logsthrough the hospital network, out onto the Internet, thence onto theserver. The data is encrypted, and compressed so as to minimize thebandwidth necessary for each session. This reduction in bandwidth usageis important to many clinics, so that a drain on hospital networkingresources is minimized, or as in the case of the information generatedby the samples dispensing locations using modems is none.

[0211] Methods of redistribution of samples include, but are not limitedto, email, fax, website, and a planned integrated voiceresponse(IVR)system. The server aggregates the information into a seriesof larger databases, while keeping information accessible that is uniqueto an installation by using a unique key for each individual location.In this manner, access to the information can be attained as anaggregate of a market, or as an individual dispensing location,depending upon the need. For example, Microsoft® SQL 6.5 acts as themain database repository engine.

[0212] In a particular, preferred embodiment, for the server processes,Allaire's ColdFusion™ web site database management and developmentsolution can be used. Allaire is a web site development language andsolution company with tools for data management over the Internet. Otherdatabase management and development solutions can be used. Each customeris offered a unique view of the aggregated data based upon the customersbuying level.

[0213] Using password access, the preferred embodiment offers a usernearly real time sample dispensing information. In addition, based uponbuying levels, daily, weekly, or monthly reports via email are provided.

[0214] In another preferred embodiment, a process that can be broken upinto a series of questions that can be responded to using a telephonekeypad is programmed using an IVR. A follow-on device can be providedfor patients to interact with regard to their prescriptions. Medicationsused for treating various mental incapacities have a history of sideeffects ranging from mild to severe. These medications are typicallyquite expensive. In cases of severe side effects, the patient's entireprescription is destroyed and another new and different prescription isgenerated. The destroyed medications are a complete loss to thedispensing institution and the patients' insurer. Using samples, and anIVR system, a complete costly prescription is not given to a patientuntil the patient has completed a duration of free samples to determineif side effects are severe enough to warrant a different therapyapproach.

[0215] A patient can query a prearranged IVR number to indicate thatside effects are, or are not, present in his or her currently selectedtherapy regime. If the patient can tolerate the tested samples, then theIVR can trigger the hospital pharmacy, an online pharmacy company like,for example, PlanetRx.com, or redirect the Rx to a mail order facility,a complete therapy cycle based upon the norms of the institution. Wherean expensive prescription might have been wasted the patient can test afree sample of the medication before determining if a complete cycle oftherapy would be effective without severe side effects.

[0216] A user, instead of dialing an IVR system, launches their favoriteweb browser using an Internet service such as, for example,AmericaOnLine or any other Internet access provider, and complete aseries of simple questions about the sample of medicine, before beingissued a complete therapy cycle. The therapy cycle can be redirected tomany different locations, including, again the originating hospitaloutpatient pharmacy, a mail order house, etc.

[0217]FIGS. 16A through 22 illustrate embodiments of screens of thesoftware component of the sample dispensing. The screens can bedisplayed by a monitor of a drug dispenser. In a preferred embodiment,the monitor is a touch screen. Therefore, it is possible for a user tointeract with the dispenser by using the monitor and the screens shownin FIGS. 16A through 22 to provide commands to the dispenser 1500. Touse the touchscreen monitor, the user must press the tip of a capacitiveitem, such as a finger against the screen. Non-capacitive items, such,as fingernails or pointed objects, will not work. In another embodiment,the user can also use a mouse or a keyboard to interact with thecommands and options presented on the screens.

[0218]FIGS. 16A through 16E illustrate a method of dispensing drugsamples from the sample dispenser 1500 and embodiments of screensassociated with dispensing samples. FIG. 16A shows an introductionscreen 1400 having a dispense command 1402 and a maintenance command1404. To engage the dispenser to dispense drugs, the user can select thedispense command 1406. The user can then be presented with a subscribername screen 1408, as shown in FIG. 16B. The user can select the firstinitial of the prescriber's last name 1410 using letter keys 1412. Theuser can then select the prescriber name 1414 from the screen 1408.Next, the user types in the patient name 1416 in a patient name area.Theuser can then proceed 1420 by selecting; a next command 1426.

[0219]FIG. 16C shows a medication screen 1422 which can follow thesubscriber name screen 1408. A user can select the first letter of amedication 1424 he wishes to receive using the letter buttons 1412provided. A list of medications can then be listed on the screen 1422.The user can select the medication 1428 he requires by touching theportion of the screen corresponding to his drug choice. The user canselect the number of packages he requires 1430 using the packagequantity buttons 1432. The number of packages is not equivalent to thenumber of doses needed for a patient, since one package can havemultiple doses of medication. The user can then proceed 1434 byselecting the next command 1426.

[0220]FIG. 16D shows a SIGS screen 1442 which can follow the medicationscreen 1422. The user can select one of the provided SIGS or use hespace at the bottom to create a custom SIG 1436. The user can edit boththe lot number and expiration date 1438 of the medication. The user canthen proceed 1440 by selecting a next command 1426. The user can then bepresented with a dispense summary screen 1442, shown in FIG. 16E. Theuser can then review all entries to make sure they are correct 1444. Theuser can also check the printer to ensure that paper is available 1444.The user can chose to give the same patient additional medications 1446,restart the process 1448 or select a finish command to print labels andmonographs for the patient 1450.

[0221]FIGS. 17A through 17C illustrate a method of loading medicationsinto a dispenser. The user can first be presented with an introductionscreen 1400 having a maintenance command 1404, shown in FIG. 17A. Theuser can select the maintenance command 1446 to proceed with the loadingof medications. The user can then be presented with a menu screen 1448having a load command 1450, a databases command 1452, a reports command1454 and a return to introduction screen command 1458. The user canselect the load command 1458 to proceed. The user can then be presentedwith a user identification screen 1460 where the user can enter his nameand his company's name before proceeding. After the data has beenentered, the user can select a next command 1462 to continue.

[0222]FIG. 17B illustrates a medication screen 1464, which follows theuser identification screen 1460. The user can select the first letter ofthe medication to be loaded 1466 from the letter buttons 1412. The usercan then be presented with a list of drugs having names starting withthe chosen letter. The user can then select the medication to be loaded1468 from the screen 1464. The user can proceed by selecting a nextcommand 170, which brings him to a medication data screen 1472, shown inFIG. 17C. In the medication data screen 1472, the user can enter the lotnumber, the expiration date and the quantity of the medication added1474 to the dispenser. The medication data screen 1472 includes a savecommand 1476 and a quit—no save command 1478. After entering the dataand hitting the tab key to move through the screens, the user can checkhis entries and execute the save command if they are correct or executea the quit—no save command if they are incorrect 1480.

[0223]FIGS. 18A through 18D illustrate a method to view or editinventory within the dispenser. The user can first be presented with anintroduction screen 1400 having a maintenance command 1404, shown inFIG. 18A. The user can select the maintenance command 1446 to proceedwith the loading of medications. The user can then be presented with amenu screen 1448 having a load command 1450, a databases command 1452, areports command 1454 and a return to introduction screen command 1458.The user can select the databases command 1482 to proceed. A databasescreen 1484 can then be presented to the user as illustrated in FIG.18B.

[0224] The database screen 1484 can include an inventory command 1486, aprescriber command 1487, a transactions command 1488 and a load command1489. To view or edit inventory in the dispenser, a user can select theinventory command 1490 and select a medication 1492 shown on the screen1484. The screen 1484 can present manufacturer and bar code informationof the medications, in addition to medication names. The user can thenmanipulate the inventory database 1494 by either editing or deleting thedatabase selection. When editing the database selection, an inventorydatabase editor screen 1495 can appear, as shown in FIG. 18C. On thisscreen 1495, the user can edit items or add new items to the database1496. To add new items to the database, the user can select theinventory command 1486, select the edit command 1330 and select amedication from the screen 1484. Any medication can be selected since itwill immediately be changed. The user can then select the clear allfields command 1332, enter data into the blank fields shown on thescreen 1495 and select the save command 1334.

[0225] The user can opt to get new GCN number and apply the new GCNnumber 1498 from the inventory database editor screen 1495. A GCN numberis assigned to drugs that belong in the same class and can be used tocreate a monograph that the patient receives in the dispense process. Ifthe use chooses to get and apply a new GNC, the user can be presentedwith a GCN screen 1300, shown in FIG. 18D. From this screen, the usercan select a new GCN number by picking the actual medication or itsclosest therapeutic equivalent from the screen 1300. Whichever item isselected will have its GCN number added to the NEW GCN textbox 1306 onthe inventory database editor screen 1495. The user can return to theinventory database editor screen 1308 and choose to save the new data orrestore the previous data 1310.

[0226]FIGS. 19A through 19C show a method to view or edit a prescriberwithin the database of the dispenser. The user can first be presentedwith an introduction screen 1400 having a maintenance command 1404,shown in FIG. 19A. The user can select the maintenance command 1446 toproceed with the loading of medications. The user can then be presentedwith a menu screen 1448 having a load command 1450, a databases command1452, a reports command 1454 and a return to introduction screen command1458. The user can select the databases command 1482 to proceed. Adatabase screen 1484 can then be presented to the user as illustrated inFIG. 19B.

[0227] The database screen 1484 can include an inventory command 1486, aprescriber command 1487, a transactions command 1488 and a load command1489. To view or edit a prescriber in a database interfaced with thedispenser, a user can select the prescriber command 1310 and select aprescriber 1312 shown on the screen 1484. The user can then remove theselected prescriber from the database or edit the prescriber informationto add him to the database 1314. If the user chooses to add a newprescriber, he can be presented with a prescriber database editor screen1316, shown in FIG. 19C. The user can enter a new prescriber name andreturn to the database screen 1318.

[0228]FIGS. 20A and 20B illustrate a method to view a transaction madewith the dispenser. The user can first be presented with an introductionscreen 1400 having a maintenance command 1404, shown in FIG. 20A. Theuser can select the maintenance command 1446 to proceed with the loadingof medications. The user can then be presented with a menu screen 1448having a load command 1450, a databases command 1452, a reports command1454 and a return to introduction screen command 1458. The user canselect the databases command 1482 to proceed. A database screen 1484 canthen be presented to the user as illustrated in FIG. 20B.

[0229] The database screen 1484 can include an inventory command 1486, aprescriber command 1487, a transactions command 1488 and a load command1489. To view the transactions made with the sample dispenser 1500, auser can select the transaction command 1320. The transaction databasecan be used for viewing purposes only. The user can view thetransactions by transaction number or by transaction date, for example.

[0230]FIG. 21 illustrates a method viewing the load history of thedispenser. The user can first be presented with an introduction screen1400 having a maintenance command 1404. The user can select themaintenance command 1446 to proceed with the loading of medications. Theuser can then be presented with a menu screen 1448 having a load command1450, a databases command 1452, a reports command 1454 and a return tointroduction screen command 1458. The user can select the databasescommand 1482 to proceed. A database screen 1484 can then be presented tothe user.

[0231] The database screen 1484 can include an inventory command 1486, aprescriber command 1487, a transactions command 1488 and a load command1489. To view the database showing the medications loaded into thedispenser, a user can select the load command 1322. The database showingthe medications loaded can be used for viewing purposes only. Thedatabase screen 1484 can show various types of load data, including loaddate, drug potency, and quantity.

[0232]FIG. 22 illustrates a method of viewing reports of the database ofthe dispenser. The user can first be presented with an introductionscreen 1400 having a maintenance command 1404. The user can select themaintenance command 1446 to proceed with the viewing of reports. Theuser can then be presented with a menu screen 1448 having a load command1450, a databases command 1452, a reports command 1454 and a return tointroduction screen command 1458. The user can select the reportscommand 1324 to proceed. A reports screen 1326 can then be presented tothe user. The user can then select a report 1328 from the screen 1326that lie wishes to view. For example, an inventory report can be chosenand viewed by the user.

[0233]FIGS. 23A and 23B show a preferred embodiment of a sampledispenser 1500 the hardware system of sample dispensing. The dispenser1500 can have a computer 1560 located within a computer housing 1502, amonitor 1504, a printer 1506 and a control system 1518 located within acontrol system housing 1546. The dispenser 1500 can also have doors 1508holding a plurality of bins 1510, a camera 1512 and a useridentification system 1514. FIG. 23A shows a door 1508 of the dispenser1500 in an open position. FIG. 16B shows a door 1508 of the dispenser1500 in a closed position.

[0234]FIGS. 24A and 24B illustrate an embodiment of the computer housing1502 in an open and a closed position, respectively. The computerhousing 1502 can be opened and closed in order to allow restrictedaccess to the computer for rebooting or servicing. The computer housing1502 can have a stationary portion 1562 and a moveable portion 1564. Thestationary 1562 and moveable 1564, portions can be attached by at leastone hinge 1566. In a preferred embodiment, two hinges 1566 connect thestationary 1562 and moveable 1564 portions of the housing 1502. Themoveable portion 1564 of the housing 1502 can include side rails 1568and the stationary portion 1562 of the housing 1502 can have side walls1570. The rails 1568 and walls 1570 can limit the motion of the moveableportion 1564 and the computer 1560 as the moveable portion 1564 isopened by a user. When the moveable portion 1564 is opened, the siderails 1568 can engage side walls 1570 of the stationary portion 1562 ofthe housing 1502, thereby preventing further rotation of the moveableportion 1564 of the housing 1502. Opening the computer housing 1502 canallow user access to the computer 1560.

[0235]FIG. 25 shows a computer 1560 mounted on a moveable portion 1564of a housing 1502. In one embodiment, the housing 1502 can have pistons1570 or dampeners mounted between the moveable portion 1564 and thestationary portion 1562. In the embodiment shown, the pistons 1570 canbe mounted between movable portion brackets 1574 and stationary portionbrackets 1576. The pistons 1570 can help to control the speed at whichthe moveable portion 1564 travels when the computer housing 1502 isopened.

[0236] The computer housing 1502 can have a computer 560 which caninclude a motherboard, a CPU, a network interface card, a hard drive anda modem. In a preferred embodiment, the computer housing 1502 caninclude an Asus motherboard, an Intel Pentium™ II CPU, a 3Com 3C90Xnetwork interface card, a Western Digital hard drive and a 3Com U.S.Robotics modem. The hard drive can have between a 4 and 6 gigabytecapacity, for example. The modem can be either an internal or anexternal modem. The monitor 1504, in a preferred embodiment, is a touchscreen such as, for example, a MicroTouch screen which allows users toenter commands into the computer. The computer can also include akeyboard to allow commands to be entered into the computer. The printer1506 can be a laser jet or a color ink jet, for example.

[0237] A camera 1512 can be mounted to the dispenser 1500, as shown inFIGS. 23A and 23B, and can be used to create a photographic record ofall users of the sample dispenser 1500. Such a record can be used forsecurity at the sample dispenser 1500 and to discourage tampering at thedispenser 1500. The camera 1512 can be triggered by some predeterminedevent to automatically take a picture of the area surrounding thedispenser. In one embodiment, a proximity sensor can be electronicallycoupled to the camera 1512 and can cause the camera 1512 to snap apicture based upon some external event. For example, if a user were tomove within a certain distance of the dispenser 1500, the proximitysensor detects such a motion and causes the camera 1512 to automaticallycapture an image of an area surrounding the dispenser 1500. In anotherembodiment, the camera 1512 can be coupled with the user identificationsystem 1514 such that engaging the system 1514 causes the camera 1512 totake a picture. For example, if a user were to attempt to use theidentification system 1514, either successfully or unsuccessfully, suchan attempt triggers the camera 1512 to snap a photograph. In anotherembodiment, the camera 1512 can be connected with the doors 1508 of thedispenser 1500 such that opening the doors 1508 causes the camera 1512to snap a picture of an area surrounding the dispenser 1500. The camera1512 can have a control system which can be a computer. The computerwhich controls the camera 1512 can be separate from the computer whichcontrols the dispenser 1500 or integrated with it.

[0238] The sample dispenser 1500 can also have a user identificationsystem 1514 to protect against unauthorized access. The useridentification system 1514 can be used as a security device to permitauthorized user access to the medications dispensed by the dispenser. Inthis system 1514, a user would be required to provide some paper form ofidentification to the system 1514 before the doors 1508 of the dispenser1500 could be opened. The user identification system 1514 can be used inconjunction with a locking mechanism to provide security for thedispenser 1500. In one embodiment, the user identification system 1514operates by identifying a fingerprint of a user. In a preferredembodiment, the user identification system 1514 operates by identifyinga thumb print of a user. To access the dispenser 1500, a user places afinger or a thumb against the user identification system 1514. If theuser's fingerprint was recognized by the user identification system1514, a locking mechanism in the dispenser 1500 is released and thedoors 1508 opened. If the user's fingerprint was not recognized by theuser identification system 1514, the locking mechanism in the dispenseris not be released, thereby preventing access to the samples in thedispenser 1500. The user identification system 1514 can have a controlsystem which can be a computer. The computer which controls the useridentification system 1514 can be separate from the computer whichcontrols the dispenser 1500 or integrated with it. It should be notedthat the user identification system can include, but is not limited to,hospital identification cards, credit card, debit card, otheridentification paperwork, keyword or password access using a keypad.

[0239] The sample dispenser 1500 can also have doors 1508. The doors1508 can house a plurality of bins 1510 which can be used to contain ororganize samples within the dispenser 1500. Each door 1508 can beconnected to the dispenser by a hinge 1516.

[0240]FIG. 26A shows a control system 1518 for the doors 1508. Thecontrol system 1518 can include a belt 1520 having at least one block1524 attached therein and having a set of rollers 1522 to control themotion of the belt 1520. In one embodiment, the blocks 1524 are boltedto the belt 1520. In another embodiment, the belt 520 is a chain drive.In one embodiment, the rollers 1522 can be gears. The rollers 1522 canbe connected to a control system which can control the motion of therollers 1522, thereby providing automatic opening and closing of thedoors 1508. The control system can include a computer.

[0241] Each door 1508 can be connected to a first end 1532 of a rod 1530at a pivot 1528 on the door 1508. A second end 1534 of each rod 1530 canbe attached to a pivot 1526 on each block 1524. The rods 1530 connectthe doors 1508 to the motion control system 1518. The pivots 1528 on thedoors 1508 allow the doors 1508 to rotate about their hinges 1516without impingement from the rods 1530. Similarly, the pivots 1526 onthe blocks 1526 allow the rods 1530 to follow the rotational motion ofthe doors 1508 without impinging this motion.

[0242]FIG. 26A also shows the control system 1518 in various stages ofoperation. The control system 1518 can control the positioning of thedoors 1508. In a first stage 1536, the doors 1508 are in a closedposition, with a side door portion 1544 forming a zero degree angle witha centerline 1542. The blocks 1524 are located on the belt 1520 near thecenterline 1542 of the control system 1518. The belt 1520 causes therods 1530 to create a force on each door 1508 directed toward thecenterline 1542, thereby holding the doors 1508 in a closed position. Ina second stage 1538, the doors 1508 are half-opened, with a side doorportion 1544 forming a forty-five degree angle with the centerline 1542.In this position 1538, each block 1524 is forced to move away from thecenterline 1542 of the system 1518 by the belt 1520, in an openingmotion, or forced to move toward the centerline 1542 of the system 1518by the belt 1520, in a closing motion. In an opening motion, the belt1520 causes each rod 1530 to create a force against each respective door1508, directed away from the centerline 1542, thereby forcing the doors1508 in a partially open position. In a closing motion, the belt 1520can cause each rod 1530 to create a force on each respective door 1508,directed toward the centerline 1542, thereby forcing the doors 1508 in apartially open position. In a third stage 1540, the doors are fullyopened, with a side door portion 1544 forming a ninety degree angle witha centerline 1542. In this position 1540, each block 1524, again, hasbeen forced to move away from the centerline 1542 of the system 1518 bythe belt 1520. The motion of the belt 1520 to this position 1540 furthercauses each rod 530 to create a force against each respective door 1508,directed away from the centerline 1542, thereby, forcing the doors 1508into a fully open position.

[0243] The motion system 1518 can be operated automatically. Suchoperations can provide security for the dispenser 1500 and can limituser access to the device 1500. When operated, the control system 1518can cause the doors 1508 to expand or contract to an open or closedposition, respectively. Automatic operation of the control system 1518can be triggered by some predefined event. For example, in oneembodiment, the doors 1508 can be programmed to be opened by the motioncontrol system 1518 only when the user provides positive identification.Also, the doors 1508 can be programmed to automatically close after aset time period has elapsed. In another embodiment, the doors 1508 canalso be caused to close when the user moves away from a proximity sensorlocated on the dispenser 1500. For automatic operation of the controlsystem 1518, the system 1518 can be controlled by a computer. Thecomputer which controls the system 1518 can be separate from thecomputer which controls the dispenser 1500 or integrated with it.

[0244] The sample dispenser 1500 can also include a bar code reader, oran electronic reader in an alternate embodiment. The samples held by theplurality of bins 1510 can include bar codes. The inclusion of a barcode reader on the sample dispenser 1500 can allow a user to quickly andaccurately create a record of the samples removed from the sampledispenser 1500 and the dates and times of removal, for example.

[0245]FIG. 26B illustrates a detailed, overhead view of the controlsystem 1518 shown in FIG. 26A. The control system 1518 can have ahousing 1550 to which the belt 1520, rollers 1522 and blocks 1524 aremounted. The housing 1550 can also hold and secure these components1520, 1522 and 1524 to the motion control system housing 1546. Thehousing 1550 can have flanged portions 1552 which allow for attachmentof the housing 1550 to the control system housing 1546. The controlsystem 1518 can also have a shank 1554 attached to the housing 1550.Each block 1524 can have a groove formed therein such that the groove ineach block 1524 mates with the shank 1554. The blocks 1524 can bemounted on the shank 1554 such that the blocks 1524 can slide along thelength of the shank 1554. In a preferred embodiment, the shank 1554 is araised steel rod.

[0246]FIGS. 27A through 27D illustrate an embodiment of a bin 1608 for asample dispenser 1500. The bins 1608 can be used to store and organizedrugs within the dispenser 1500. In the embodiment shown, the bin 1608have a housing 1614 with a front end 1610 and a back end 1612. Thehousing 1614 includes a handle 1620, a pushing device 1616 and acontinuous torsion spring 1618. The handle 1620 is used to aid inremoving the bin 1608 10 from the dispenser 1500. When the bin 1608 isempty, the pushing device 1616 is forced to the front end 1610 of thebin 1608 by the continuous torsion spring 1618. A user can then loadmedicines or drug packages into the bin 1608 by moving the pushingdevice 1616 to the back end 1612 of the bin 1608. Such motion providesstorage space for the medicine and extend the continuous torsion spring1618. As drug packages are removed from the bin 1608, the pushing device1616 is forced toward the front end 1610 of the bin 1608 by thecontracting continuous torsion spring 1618. In this embodiment, the usercan know immediately whether a bin 1608 is empty or full. Incrementing asecond drug package to the front end 1610 of the bin 1608 when a firstdrug package is removed ensures that a package will always be readilyavailable. Such a unit can save the user time in guessing whether a binis entirely empty or contains a package “hidden” in the back of a bin.

[0247] In another preferred embodiment, a drug dispenser dispensenon-prescription, over-the-counter drugs to patients who can positivelyidentify themselves to the drug dispenser system. FIGS. 28 through 34illustrate embodiments of user interactive touch screens which can beused with such a system. The screens can provide a way for a user tointeract with the software at the non-prescription dispenser.

[0248]FIG. 28 shows an introduction screen 1560 for a touch screenmonitor of a non-prescription drug dispenser. The introduction screen1560 can include a start command 1562, language option command 1564 anda demonstration command 1566. The start command 1562 can allow a user toprogress through subsequent screens and choose the non-prescriptiondrugs they wish to receive. The language option command 1564 allow auser the choice of language for subsequent display screens. Thedemonstration command 1566 can provide a demonstration of how the drugdispenser works. The introduction screen 1560, and all subsequentscreens, can include an end command 1568 which allows a user to exit thescreens at any point.

[0249]FIG. 29 illustrates a drug category selection screen 1570 havingdrug category selections 1572 and a reset command 1574. The drugcategory selections 1572 allows a user to select the drug categoriesfrom which they would like to receive products. The drug categories caninclude medications for allergies, antacids, cold/flu, creams/lotions,hemorrhoids, laxatives, pain relievers and vitamins, for example. Thereset command 1574 allows the user to start over or cancel hisselection, if the wrong selection had been made.

[0250]FIG. 30 illustrates a drug availability screen 1576 showing theavailability of different dugs within a selected category. If a userselected Pain Relievers as a drug category, the screen shown in FIG. 30can provide the user with a list of the types of pain relieversavailable. For example, under the pain relievers category, a user canchoose from aspirin, children's aspirin, acetaminophen, ibuprofen ornon-aspirin acetaminophen. The user can choose the drugs he wishes toreceive, using the drug selection commands 1578. Each drug selectioncommand 1528 can be associated with a particular drug. The drugavailability screen 1576 can also have a drug list command 1580 which,when activated, can show the user a list of all of the drugs he hasselected.

[0251]FIG. 31 shows a drug list screen 1582 which lists the user'sselection of drugs 1588. The drug list screen 1582 can include drugselection commands 1598 which allow a user to delete certain drugchoices from the list. In one embodiment, to delete a drug choice, auser can touch a drug selection commands 1598 corresponding to the drugto be removed from the list. The drug list screen 1582 also shows a“continue” command 1584 and a “done” command 1586. The “continue”command 1584 allows the user to make further drug selections. The “done”command 1586 allows the user to exit the drug selection screens andreceive the drugs he has chosen.

[0252]FIG. 32 illustrates a user identification screen 1590. This screen1590 instructs the user to identify himself to the drug dispensingsystem, in order for the drugs to be dispensed. In one embodiment, theuser can be instructed to swipe his Veteran's Administration cardthrough a card reader. The information on the user's card can then becompared to information within the system's database to determine theuser's eligibility to receive the requested drugs. The useridentification screen 1590 can also include user identificationindicator buttons 1592. The buttons 1592 can include a positiveidentification button 1594, which indicates the user's identification asvalid, or a negative identification button 1596, which indicates theuser's identification as invalid.

[0253]FIG. 33 shows a ready-to-dispense screen 1600 which can indicatethe drugs the user has selected and will be dispensed. Theready-to-dispense screen 1600 can also include drug selection commands1602 which allow a user to delete certain drug choices from the list. Inone embodiment, to delete a drug choice, a user can touch a portion ofthe touch screen corresponding to a drug selection command 1602 which,in turn, corresponds to the drug to be removed from the list. Theready-to-dispense screen 1600 can also have a drug dispense command1604. When a user is satisfied with his drug request, he can touch thisbutton to begin the drug dispensing procedure.

[0254]FIG. 34 shows an ending screen 1606. The ending screen 1606 canprovide instructions to the user involving picking up drugs from thedispenser tray and taking information from the printer. The endingscreen 34 can also indicate to the user that the request is beingprocessed and delivered.

[0255]FIGS. 35 and 36 illustrate an embodiment of an over-the-counter(OTC) medication dispenser 1650. The OTC medication dispenser 1650 canhave a housing 1684 which includes a door 1652, drug storage trays 1654,a labeling device 1656, electronics 1658, a user identification system1660, a computer 1666, a security monitoring device 1668, a magneticcard reader 1672 and a pickup location 1674. The computer 1666 caninclude a display 1662 and a printer 1664 having a paper pickup location1674. The display 1662 can be a touch screen display. The display screencan display materials such as, for example, advertisement materialpertinent to the non-prescription drugs or related educational material.The door 1652 is shown in an open position to better illustrate the drugstorage trays 1654 of the medication dispenser 1650.

[0256] Both the user identification system 1660 and the magnetic cardreader 1672 can be used to either permit or prevent a user's access tothe medication dispenser 1650. The user identification system 1660 canbe a fingerprint reader and, preferably, is a thumb print reader.However, other user identification systems can be incorporated, such as,for example, but not limited to, credit card, debit card, and smart cardreader systems. The user identification system 1660 can compare theuser's fingerprint data against fingerprint data contained in a databaseinterfaced with the dispenser 1650. The magnetic card reader 1672 canread information from a user's medication dispenser card, such as aVeteran's Administration card, and compare the information to thatwithin a database interfaced with the dispenser 1650. In either the useridentification system 1660 or the magnetic card reader 1672, if theuser's information is present in the database, the user will be allowedto proceed and can receive his requested medication. Conversely, if theuser's information is not located in the database, the user will not beable to proceed within the system or receive any medication. A dispenser1650 can include either the user identification system 1660 or themagnetic card reader 1672, or both, depending upon the level of securityrequired by the customer. For example, a dispenser 1650 located in adoctor's office can require a different level of security than adispenser 1650 located in a methadone clinic. For customer's requiring ahigh level of security, the dispenser 1650 can include both the useridentification system 1660 and the magnetic card reader 1672.

[0257] The electronics 1658 can include a camera, speakers or amicrophone. The speakers or microphone can allow for user interactionwith the computer 1666 with the presence of a voice recognition system.The camera can be connected to the security monitoring device 1668. Thesecurity monitoring device 1668 can detect tampering of the dispenser1650. In one embodiment, the security monitoring device 1668 can be aninfrared detector. In another embodiment, the security monitoring device1668 can be a vibration recorder. If the dispenser 1650 was tampered,the security monitoring device could cause the camera to create aphotographic record of the area surrounding the dispenser 1650, forexample. In one embodiment, the photographic record could be a digitalimage which could then be transferred to a monitoring station, byway ofmodem technology, for example.

[0258] The drug storage trays 1654, as shown in FIG. 36, can include adispensing device. In a preferred embodiment, the dispensing device caninclude helix coils 1680. In a preferred embodiment, the helix coils1680 are motor driven and allow the dispensing of medications to a user.When a user selects a medication to be dispensed from the dispenser1650, the helix coil 1680 corresponding to the chosen medication can beforced to rotate, thereby causing the medication to move toward the door1652 of the dispenser 1650 and into a collection tray 1676 located onthe door 1652. The drug storage trays 1654 can also include dividers1682. The dividers 1682 can be adjustable within the trays 1654 suchthat the trays 1654 can accommodate medication packages of varying sizesor shapes. The rotation of the helix coils 1680 can be controlled bysome control system, such as a computer for example.

[0259] The door 1652 can be used to secure the drug storage trays 1654and the medications within the housing 1684 of the OTC medicationdispenser 1650. The door 1652 can include lifting mechanisms 1678, whichare shown without the door 1652 in FIG. 37. The door 1652 can alsoinclude a collection tray 1676, a pushing device 1686 and a pushingdevice control 1688.

[0260] In a preferred embodiment, the lifting mechanisms 1678 are S-raillifting screws. The S-rail lifting screws can be threaded through thecollection tray 1676 and can rotate about a central axis, either in aclockwise or a counterclockwise direction, thereby causing thecollection tray 1686 to translate in an upward or downward direction.The S-rail lift screws can also be Teflon coated to provide for smoothtranslation of the collection tray 1676.

[0261] The collection tray 1676 can be used to collect medicine packagesfrom the drug storage trays 1654 and deliver the packages to thelabeling device 1656. By allowing for the collection tray 1676 totranslate upwards and downwards, the tray 1676 can collect medicinepackages from drug storage trays 1654 located along the entire height ofthe dispenser 1650. Positioning the collection tray 1676 at a particulardrug storage tray 1654 from which a package is being dispensed preventsthe medicine in the package from being damaged by an impact after beingdispensed. The positioning at the collection tray 1676 can be controlledby a control system, such as a computer, for example.

[0262] The collection tray 1676 can include a pushing device 1686 whichcan be used to move medical samples from the collection tray 1676 intothe labeling device 1656. The pushing device 1686 can include a pushingdevice controller 1688 which controls the positioning of the pushingdevice 1686. In one embodiment, the pushing device controller 1688 is anS-rail screw. In another embodiment, a conveyor can be used as thepushing device controller 1688. The pushing device controller 1688 canbe driven by a control system, such as a computer, for example.

[0263] When a user wishes to retrieve drugs from the OTC medicationdispenser 1650, he can first be prompted to provide his identification,either by utilizing the user identification system 1660 or the magneticcard reader 1672, or both and can then enter his medication choices intothe computer 1666. In another embodiment, the user can first be promptedto enter his drug choices and then be required to provide hisidentification to the dispenser 1650. Next, the collection tray 1676 canbe forced to move, in either an upward or downward direction, to thedrug storage trays 1654 which contain the requested medication. Thehelix coils 1680 can then be forced to rotate in the drug storage trays1654 so as to advance the selected medication into the collection tray1676. The collection tray 1676 can then be caused to move upwards ordownwards to the labeling device 1656. The pushing device 1686 of thecollection tray 1676 can then be caused to push the medication from thecollection tray 1676 into the labeling device 1656. In the labelingdevice 1656, the drug can be identified by a bar code reader which canread the medication's bar code. The labeling device 1656 can also applya label to the medication. The labeling device 1656 can then transferthe medication to the pickup location 1674. In a preferred embodiment,the labeling device 1656 can transfer the medication to the pickuplocation 1674 by a conveyance mechanism, such as an S-rail or aconveyor. In a preferred embodiment, the pickup location 1674 can have acover which can be automated. When the medications arrive at the pickuplocation 1674, as requested by the user, the cover can open. Once theuser removes the requested medications, the cover can automaticallyclose and secure itself to the pickup location 1674.

[0264] Without limiting the generality of the claimed invention, thoseskilled in the art can appreciate that the components of the dispensingsystem—physical and program code—can be physically split and operatedfrom different locations, connected together by a computer network.Further, components of the system can be divided and owned and operatedby multiple entities, connected by a computer network if applicable.

[0265] It will be apparent to those of ordinary skill in the art thatmethods involved in the remote dispensing of pharmaceuticals or othermedical products can be embodied in a computer program product thatincludes a computer usable medium. For example, such a computer usablemedium can include a readable memory device, such as a hard drivedevice, a CD-ROM, a DVD-ROM, or a computer diskette, having computerreadable program code segments stored thereon. The computer readablemedium can also include a communications or transmission medium, such asa bus or a communications link, either optical, wired, or wireless,having program code segments carried thereon as digital or analog datasignals.

What is claimed:
 1. A method for dispensing medical sample products froma sample dispenser comprising the steps of: storing a plurality ofmedical sample products in a sample dispenser; verifying a user'sidentification and ability to receive medical sample products from thesample dispenser; using a control system to provide user access to theplurality of medical sample products in the dispenser, the controlsystem actuating movement between a closed position and an openposition; removing a subset of the plurality of medical sample productsfrom the dispenser in the open position and recording the subset ofmedical sample products into a database; generating a monograph for apatient; and using the control system to secure the sample dispenser inthe closed position such that further user access to the medical sampleproducts is prevented.
 2. The method for dispensing medical sampleproducts of claim 1, wherein the monograph includes at least one ofpatient specific information, directions for use, name and strength of aprescription drug, warnings, possible side effects and quantitydispensed.
 3. A medical sample product dispenser comprising: a housing;a plurality of storage bins mounted within the housing, the plurality ofstorage bins containing a plurality of medical sample products; acontrol system operably coupled to the housing to control user access tothe dispenser, the control system actuating movement between a closedand an open position; a computer mounted within the housing; a useridentification system mounted to the housing; and a monograph generatingdevice mounted to the housing.
 4. The medical sample product dispenserof claim 3, wherein the computer is in communication with a databasedata processor.
 5. The medical sample product dispenser of claim 4,wherein the database data processor is accessed by a plurality ofmanufacturers of the medical sample product dispenser.
 6. The medicalsample product dispenser of claim 3, wherein the medical sample productdispenser further comprises at least one door mounted to the housing, atleast one door having a plurality of bins.
 7. The medical sample productdispenser of claim 3, further comprising a proximity sensor.
 8. Themedical sample product dispenser of claim 3, further comprising a labeldispenser.
 9. The medical sample product dispenser of claim 3, whereinthe computer is connected to a communication network.
 10. The medicalsample product dispenser of claim 3, further comprises an actuator toopen and close doors on the dispenser.
 11. The medical sample productdispenser of claim 3, wherein the computer is in communication with aserver.
 12. The medical sample product dispenser of claim 9, furthercomprising an internet connection.
 13. A system to connect to medicalproduct package dispenser comprising: wireless communication device; anda dispensing system having a wireless port; the wireless communicationdevice being in wireless communication with the dispensing system toactuate dispensing of packaged medical products.
 14. The system of claim13, wherein the wireless communication device comprises a satellitesystem.
 15. The system of claim 13, wherein the wireless communicationdevice comprises a pager system.
 16. The system of claim 13, wherein thewireless communication device comprises a personal digital assistant.17. The system of claim 13, wherein the wireless communication device isin communication with a communication network.
 18. The system of claim13, further comprising a controlling data processor in communicationwith the wireless communication device.
 19. The system of claim 18,wherein the controlling data processor and the wireless communicationdevice communicate via a network.
 20. The system of claim 13, whereinthe packaged medical product is a prescription pharmaceutical.